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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR Fluoroscopy in Imaging per Hour","code_information":[{"code":"3700098","type":"CDM"},{"code":"0320","type":"RC"},{"code":"76000","type":"CPT"}],"standard_charges":[{"gross_charge":598.0,"discounted_cash":418.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price"}]},{"description":"MRI Brain w/o Contrast","code_information":[{"code":"3700101","type":"CDM"},{"code":"0610","type":"RC"},{"code":"70551","type":"CPT"}],"standard_charges":[{"gross_charge":1297.0,"discounted_cash":907.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"NM Gastrointestinal Blood Loss Imaging","code_information":[{"code":"3700132","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78278","type":"CPT"}],"standard_charges":[{"gross_charge":2208.0,"discounted_cash":1545.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR Ribs 3 Views Bilateral","code_information":[{"code":"3700185","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71110","type":"CPT"}],"standard_charges":[{"gross_charge":510.0,"discounted_cash":357.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price"}]},{"description":"MRI Spine Cervical w/ + w/o Contrast","code_information":[{"code":"3700192","type":"CDM"},{"code":"0610","type":"RC"},{"code":"72156","type":"CPT"}],"standard_charges":[{"gross_charge":2400.0,"discounted_cash":1680.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR Sternum 2+ Views","code_information":[{"code":"3700193","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71120","type":"CPT"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price"}]},{"description":"MRI Spine Thoracic w/o Contrast","code_information":[{"code":"3700200","type":"CDM"},{"code":"0610","type":"RC"},{"code":"72146","type":"CPT"}],"standard_charges":[{"gross_charge":1297.0,"discounted_cash":907.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR Sternoclavicular Joint(s)","code_information":[{"code":"3700201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71130","type":"CPT"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":264.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price"}]},{"description":"NM Bone Imaging Limited","code_information":[{"code":"3700215","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78300","type":"CPT"}],"standard_charges":[{"gross_charge":1125.0,"discounted_cash":787.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"MRI Spine Thoracic w/ Contrast","code_information":[{"code":"3700218","type":"CDM"},{"code":"0610","type":"RC"},{"code":"72147","type":"CPT"}],"standard_charges":[{"gross_charge":1297.0,"discounted_cash":907.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR Spine Scoliosis 2-3 Views","code_information":[{"code":"3700219","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72082","type":"CPT"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":518.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price"}]},{"description":"MRI Spine Thoracic w/ + w/o Contrast","code_information":[{"code":"3700226","type":"CDM"},{"code":"0610","type":"RC"},{"code":"72157","type":"CPT"}],"standard_charges":[{"gross_charge":2400.0,"discounted_cash":1680.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR Spine Lumbosacral 2 or 3 Views","code_information":[{"code":"3700268","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72100","type":"CPT"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price"}]},{"description":"MRI Pelvis w/o Contrast","code_information":[{"code":"3700275","type":"CDM"},{"code":"0610","type":"RC"},{"code":"72195","type":"CPT"}],"standard_charges":[{"gross_charge":1297.0,"discounted_cash":907.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR Spine Lumbosacral 4+ Views","code_information":[{"code":"3700276","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72110","type":"CPT"}],"standard_charges":[{"gross_charge":481.0,"discounted_cash":336.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price"}]},{"description":"Diagnostic tomosynthesis, unilateral or bilateral","code_information":[{"code":"3700279","type":"CDM"},{"code":"0401","type":"RC"},{"code":"G0279","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"MRI Pelvis w/ Contrast","code_information":[{"code":"3700283","type":"CDM"},{"code":"0610","type":"RC"},{"code":"72196","type":"CPT"}],"standard_charges":[{"gross_charge":1297.0,"discounted_cash":907.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"MRI Pelvis w/ + w/o Contrast","code_information":[{"code":"3700291","type":"CDM"},{"code":"0610","type":"RC"},{"code":"72197","type":"CPT"}],"standard_charges":[{"gross_charge":2400.0,"discounted_cash":1680.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR Sacrum/Coccyx 2+ Views","code_information":[{"code":"3700292","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72220","type":"CPT"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":308.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price"}]},{"description":"XR Spine Thoracolumbar 2+ Views","code_information":[{"code":"3700300","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72080","type":"CPT"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":359.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price"}]},{"description":"MRA Pelvis w/ + w/o Contrast","code_information":[{"code":"3700309","type":"CDM"},{"code":"0610","type":"RC"},{"code":"72198","type":"CPT"}],"standard_charges":[{"gross_charge":875.0,"discounted_cash":612.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"MRI Forearm w/o Contrast Left","code_information":[{"code":"3700317","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73218","type":"CPT"}],"standard_charges":[{"gross_charge":1297.0,"discounted_cash":907.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XR Clavicle Left","code_information":[{"code":"3700359","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73000","type":"CPT"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":245.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"XR Clavicle Right","code_information":[{"code":"3700359","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73000","type":"CPT"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":245.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MRI Elbow w/ + w/o Contrast Left","code_information":[{"code":"3700366","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73223","type":"CPT"}],"standard_charges":[{"gross_charge":2400.0,"discounted_cash":1680.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR AC Joints Bilateral","code_information":[{"code":"3700367","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73050","type":"CPT"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":196.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price"}]},{"description":"MRA Upper Extremity w/ + w/o Cnt Left","code_information":[{"code":"3700374","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73225","type":"CPT"}],"standard_charges":[{"gross_charge":875.0,"discounted_cash":612.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"MRA Upper Extremity w/ + w/o Cnt Right","code_information":[{"code":"3700374","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73225","type":"CPT"}],"standard_charges":[{"gross_charge":875.0,"discounted_cash":612.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR Scapula Left","code_information":[{"code":"3700375","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73010","type":"CPT"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":240.1,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"XR Scapula Right","code_information":[{"code":"3700375","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73010","type":"CPT"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":240.1,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MRI Tibia/Fibula w/o Contrast Left","code_information":[{"code":"3700382","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73718","type":"CPT"}],"standard_charges":[{"gross_charge":1297.0,"discounted_cash":907.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR Shoulder 1 View Left","code_information":[{"code":"3700383","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73020","type":"CPT"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":204.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"XR Shoulder 1 View Right","code_information":[{"code":"3700383","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73020","type":"CPT"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":204.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MRI Femur w/ Contrast Left","code_information":[{"code":"3700390","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73719","type":"CPT"}],"standard_charges":[{"gross_charge":1297.0,"discounted_cash":907.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR Shoulder Complete 2+ Views Left","code_information":[{"code":"3700391","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73030","type":"CPT"}],"standard_charges":[{"gross_charge":301.0,"discounted_cash":210.7,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"XR Shoulder Complete 2+ Views Right","code_information":[{"code":"3700391","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73030","type":"CPT"}],"standard_charges":[{"gross_charge":301.0,"discounted_cash":210.7,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MRI Tibia/Fibula w/ + w/o Contrast Right","code_information":[{"code":"3700408","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73720","type":"CPT"}],"standard_charges":[{"gross_charge":2400.0,"discounted_cash":1680.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"MRI Tibia/Fibula w/ + w/o Contrast Left","code_information":[{"code":"3700408","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73720","type":"CPT"}],"standard_charges":[{"gross_charge":2400.0,"discounted_cash":1680.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"MRI Foot w/ + w/o Contrast Left","code_information":[{"code":"3700408","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73720","type":"CPT"}],"standard_charges":[{"gross_charge":2400.0,"discounted_cash":1680.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR Humerus Left","code_information":[{"code":"3700409","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73060","type":"CPT"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":268.1,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"XR Humerus Right","code_information":[{"code":"3700409","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73060","type":"CPT"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":268.1,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MRI Ankle w/ Contrast Left","code_information":[{"code":"3700424","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73722","type":"CPT"}],"standard_charges":[{"gross_charge":1297.0,"discounted_cash":907.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"MRI Hip w/ Contrast Left","code_information":[{"code":"3700424","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73722","type":"CPT"}],"standard_charges":[{"gross_charge":1297.0,"discounted_cash":907.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"MRI Knee w/ Contrast Left","code_information":[{"code":"3700424","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73722","type":"CPT"}],"standard_charges":[{"gross_charge":1297.0,"discounted_cash":907.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"MRI Knee w/ Contrast Right","code_information":[{"code":"3700424","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73722","type":"CPT"}],"standard_charges":[{"gross_charge":1297.0,"discounted_cash":907.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR Elbow Complete 3+ Views Right","code_information":[{"code":"3700425","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73080","type":"CPT"}],"standard_charges":[{"gross_charge":445.0,"discounted_cash":311.5,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XR Elbow Complete 3+ Views Left","code_information":[{"code":"3700425","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73080","type":"CPT"}],"standard_charges":[{"gross_charge":445.0,"discounted_cash":311.5,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"MRI Hip w/ + w/o Contrast Left","code_information":[{"code":"3700432","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73723","type":"CPT"}],"standard_charges":[{"gross_charge":2400.0,"discounted_cash":1680.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"MRI Knee w/ + w/o Contrast Right","code_information":[{"code":"3700432","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73723","type":"CPT"}],"standard_charges":[{"gross_charge":2400.0,"discounted_cash":1680.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"MRI Knee w/ + w/o Contrast Left","code_information":[{"code":"3700432","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73723","type":"CPT"}],"standard_charges":[{"gross_charge":2400.0,"discounted_cash":1680.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT HEAD W and W/O CONTRAST","code_information":[{"code":"3750030","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70470","type":"CPT"}],"standard_charges":[{"gross_charge":1078.0,"discounted_cash":754.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price"}]},{"description":"CT Orbits Sella w/o Contrast","code_information":[{"code":"3750048","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70480","type":"CPT"}],"standard_charges":[{"gross_charge":1610.0,"discounted_cash":1127.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Neck w/o Cont","code_information":[{"code":"3750055","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70490","type":"CPT"}],"standard_charges":[{"gross_charge":864.0,"discounted_cash":604.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Neck Soft Tissue w/o Contrast","code_information":[{"code":"3750055","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70490","type":"CPT"}],"standard_charges":[{"gross_charge":864.0,"discounted_cash":604.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Chest/Abd/Pelvis w/o Contrast","code_information":[{"code":"3750063","type":"CDM"},{"code":"0350","type":"RC"},{"code":"71250","type":"CPT"}],"standard_charges":[{"gross_charge":1350.0,"discounted_cash":945.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Chest/Abdomen w/o Contrast","code_information":[{"code":"3750063","type":"CDM"},{"code":"0350","type":"RC"},{"code":"71250","type":"CPT"}],"standard_charges":[{"gross_charge":1350.0,"discounted_cash":945.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Chest w/o Cont","code_information":[{"code":"3750063","type":"CDM"},{"code":"0350","type":"RC"},{"code":"71250","type":"CPT"}],"standard_charges":[{"gross_charge":1350.0,"discounted_cash":945.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Humerus w/o Contrast Right","code_information":[{"code":"3750097","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73200","type":"CPT"}],"standard_charges":[{"gross_charge":864.0,"discounted_cash":604.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Hip w/o Contrast Right","code_information":[{"code":"3750105","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73700","type":"CPT"}],"standard_charges":[{"gross_charge":1713.0,"discounted_cash":1199.1,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Tibia/Fibula w/o Contrast Right","code_information":[{"code":"3750105","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73700","type":"CPT"}],"standard_charges":[{"gross_charge":1713.0,"discounted_cash":1199.1,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Tibia/Fibula w/o Contrast Left","code_information":[{"code":"3750105","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73700","type":"CPT"}],"standard_charges":[{"gross_charge":1713.0,"discounted_cash":1199.1,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Knee w/o Contrast Right","code_information":[{"code":"3750105","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73700","type":"CPT"}],"standard_charges":[{"gross_charge":1713.0,"discounted_cash":1199.1,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Knee w/o Contrast Left","code_information":[{"code":"3750105","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73700","type":"CPT"}],"standard_charges":[{"gross_charge":1713.0,"discounted_cash":1199.1,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Foot w/o Contrast Right","code_information":[{"code":"3750105","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73700","type":"CPT"}],"standard_charges":[{"gross_charge":1713.0,"discounted_cash":1199.1,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Foot w/o Contrast Left","code_information":[{"code":"3750105","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73700","type":"CPT"}],"standard_charges":[{"gross_charge":1713.0,"discounted_cash":1199.1,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Hip w/o Contrast Left","code_information":[{"code":"3750105","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73700","type":"CPT"}],"standard_charges":[{"gross_charge":1713.0,"discounted_cash":1199.1,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Ankle w/o Contrast Left","code_information":[{"code":"3750105","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73700","type":"CPT"}],"standard_charges":[{"gross_charge":1713.0,"discounted_cash":1199.1,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Femur w/o Contrast Right","code_information":[{"code":"3750105","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73700","type":"CPT"}],"standard_charges":[{"gross_charge":1713.0,"discounted_cash":1199.1,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Femur w/o Contrast Left","code_information":[{"code":"3750105","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73700","type":"CPT"}],"standard_charges":[{"gross_charge":1713.0,"discounted_cash":1199.1,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Ankle w/o Contrast Right","code_information":[{"code":"3750105","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73700","type":"CPT"}],"standard_charges":[{"gross_charge":1713.0,"discounted_cash":1199.1,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Abdomen w/o Cont","code_information":[{"code":"3750121","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74150","type":"CPT"}],"standard_charges":[{"gross_charge":1690.0,"discounted_cash":1183.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Abdomen w/o Contrast","code_information":[{"code":"3750121","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74150","type":"CPT"}],"standard_charges":[{"gross_charge":1690.0,"discounted_cash":1183.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Abdomen w/ Cont","code_information":[{"code":"3750139","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74160","type":"CPT"}],"standard_charges":[{"gross_charge":864.0,"discounted_cash":604.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Abdomen w/ Contrast","code_information":[{"code":"3750139","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74160","type":"CPT"}],"standard_charges":[{"gross_charge":864.0,"discounted_cash":604.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"74176 CT Abdomen and Pelvis w/o Contrast","code_information":[{"code":"3750140","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74176","type":"CPT"}],"standard_charges":[{"gross_charge":951.0,"discounted_cash":665.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price"}]},{"description":"CT Abdomen/Pelvis w/o Cont","code_information":[{"code":"3750140","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74176","type":"CPT"}],"standard_charges":[{"gross_charge":951.0,"discounted_cash":665.7,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Abdomen and Pelvis w/o Contrast","code_information":[{"code":"3750140","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74176","type":"CPT"}],"standard_charges":[{"gross_charge":951.0,"discounted_cash":665.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price"}]},{"description":"CT Abdomen and Pelvis w/ Contrast","code_information":[{"code":"3750141","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74177","type":"CPT"}],"standard_charges":[{"gross_charge":951.0,"discounted_cash":665.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price"}]},{"description":"CT Abdomen/Pelvis w/ Cont","code_information":[{"code":"3750141","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74177","type":"CPT"}],"standard_charges":[{"gross_charge":951.0,"discounted_cash":665.7,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"74177 CT Abdomen and Pelvis w/ Contrast","code_information":[{"code":"3750141","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74177","type":"CPT"}],"standard_charges":[{"gross_charge":951.0,"discounted_cash":665.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price"}]},{"description":"CT Abdomen/Pelvis w/ + w/o Cont","code_information":[{"code":"3750142","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74178","type":"CPT"}],"standard_charges":[{"gross_charge":981.0,"discounted_cash":686.7,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Abdomen and Pelvis w/ + w/o Contrast","code_information":[{"code":"3750142","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74178","type":"CPT"}],"standard_charges":[{"gross_charge":981.0,"discounted_cash":686.7,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"74178 CT Abdomen and Pelvis w/ + w/o Contrast","code_information":[{"code":"3750142","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74178","type":"CPT"}],"standard_charges":[{"gross_charge":981.0,"discounted_cash":686.7,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Abdomen w/ + w/o Cont","code_information":[{"code":"3750147","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74170","type":"CPT"}],"standard_charges":[{"gross_charge":2149.0,"discounted_cash":1504.3,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Abdomen w/ + w/o Contrast","code_information":[{"code":"3750147","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74170","type":"CPT"}],"standard_charges":[{"gross_charge":2149.0,"discounted_cash":1504.3,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Pelvis w/o Contrast","code_information":[{"code":"3750188","type":"CDM"},{"code":"0350","type":"RC"},{"code":"72192","type":"CPT"}],"standard_charges":[{"gross_charge":1478.0,"discounted_cash":1034.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Chest w/ Contrast","code_information":[{"code":"3750196","type":"CDM"},{"code":"0350","type":"RC"},{"code":"71260","type":"CPT"}],"standard_charges":[{"gross_charge":1673.0,"discounted_cash":1171.1,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Chest/Abd/Pelvis w/ Contrast","code_information":[{"code":"3750196","type":"CDM"},{"code":"0350","type":"RC"},{"code":"71260","type":"CPT"}],"standard_charges":[{"gross_charge":1673.0,"discounted_cash":1171.1,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Chest/Abdomen w/ Contrast","code_information":[{"code":"3750196","type":"CDM"},{"code":"0350","type":"RC"},{"code":"71260","type":"CPT"}],"standard_charges":[{"gross_charge":1673.0,"discounted_cash":1171.1,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Chest w/ Cont","code_information":[{"code":"3750196","type":"CDM"},{"code":"0350","type":"RC"},{"code":"71260","type":"CPT"}],"standard_charges":[{"gross_charge":1673.0,"discounted_cash":1171.1,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Chest/Abdomen w/ + w/o Contrast","code_information":[{"code":"3750220","type":"CDM"},{"code":"0350","type":"RC"},{"code":"71270","type":"CPT"}],"standard_charges":[{"gross_charge":981.0,"discounted_cash":686.7,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Chest/Abd/Pelvis w/ + w/o Contrast","code_information":[{"code":"3750220","type":"CDM"},{"code":"0350","type":"RC"},{"code":"71270","type":"CPT"}],"standard_charges":[{"gross_charge":981.0,"discounted_cash":686.7,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Chest w/ + w/o Cont","code_information":[{"code":"3750220","type":"CDM"},{"code":"0350","type":"RC"},{"code":"71270","type":"CPT"}],"standard_charges":[{"gross_charge":981.0,"discounted_cash":686.7,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Chest w/ + w/o Contrast","code_information":[{"code":"3750220","type":"CDM"},{"code":"0350","type":"RC"},{"code":"71270","type":"CPT"}],"standard_charges":[{"gross_charge":981.0,"discounted_cash":686.7,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Wrist w/ Contrast Right","code_information":[{"code":"3750246","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73201","type":"CPT"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":598.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Wrist w/ Contrast Left","code_information":[{"code":"3750246","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73201","type":"CPT"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":598.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Shoulder w/ Contrast Right","code_information":[{"code":"3750246","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73201","type":"CPT"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":598.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Shoulder w/ Contrast Left","code_information":[{"code":"3750246","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73201","type":"CPT"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":598.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Humerus w/ Contrast Right","code_information":[{"code":"3750246","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73201","type":"CPT"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":598.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Forearm w/ Contrast Left","code_information":[{"code":"3750246","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73201","type":"CPT"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":598.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Hand w/ Contrast Right","code_information":[{"code":"3750246","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73201","type":"CPT"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":598.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Elbow w/ Contrast Left","code_information":[{"code":"3750246","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73201","type":"CPT"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":598.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Elbow w/ Contrast Right","code_information":[{"code":"3750246","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73201","type":"CPT"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":598.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Humerus w/ Contrast Left","code_information":[{"code":"3750246","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73201","type":"CPT"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":598.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Hand w/ Contrast Left","code_information":[{"code":"3750246","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73201","type":"CPT"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":598.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Forearm w/ Contrast Right","code_information":[{"code":"3750246","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73201","type":"CPT"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":598.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Ankle w/ Contrast Left","code_information":[{"code":"3750253","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73701","type":"CPT"}],"standard_charges":[{"gross_charge":1860.0,"discounted_cash":1302.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Ankle w/ Contrast Right","code_information":[{"code":"3750253","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73701","type":"CPT"}],"standard_charges":[{"gross_charge":1860.0,"discounted_cash":1302.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Femur w/ Contrast Left","code_information":[{"code":"3750253","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73701","type":"CPT"}],"standard_charges":[{"gross_charge":1860.0,"discounted_cash":1302.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Femur w/ Contrast Right","code_information":[{"code":"3750253","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73701","type":"CPT"}],"standard_charges":[{"gross_charge":1860.0,"discounted_cash":1302.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Foot w/ Contrast Right","code_information":[{"code":"3750253","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73701","type":"CPT"}],"standard_charges":[{"gross_charge":1860.0,"discounted_cash":1302.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Hip w/ Contrast Left","code_information":[{"code":"3750253","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73701","type":"CPT"}],"standard_charges":[{"gross_charge":1860.0,"discounted_cash":1302.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Hip w/ Contrast Right","code_information":[{"code":"3750253","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73701","type":"CPT"}],"standard_charges":[{"gross_charge":1860.0,"discounted_cash":1302.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Knee w/ Contrast Left","code_information":[{"code":"3750253","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73701","type":"CPT"}],"standard_charges":[{"gross_charge":1860.0,"discounted_cash":1302.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Knee w/ Contrast Right","code_information":[{"code":"3750253","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73701","type":"CPT"}],"standard_charges":[{"gross_charge":1860.0,"discounted_cash":1302.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Tibia/Fibula w/ Contrast Left","code_information":[{"code":"3750253","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73701","type":"CPT"}],"standard_charges":[{"gross_charge":1860.0,"discounted_cash":1302.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Tibia/Fibula w/ Contrast Right","code_information":[{"code":"3750253","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73701","type":"CPT"}],"standard_charges":[{"gross_charge":1860.0,"discounted_cash":1302.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Foot w/ Contrast Left","code_information":[{"code":"3750253","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73701","type":"CPT"}],"standard_charges":[{"gross_charge":1860.0,"discounted_cash":1302.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Spine Cervical w/o Contrast","code_information":[{"code":"3750261","type":"CDM"},{"code":"0350","type":"RC"},{"code":"72125","type":"CPT"}],"standard_charges":[{"gross_charge":951.0,"discounted_cash":665.7,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Spine Cervical w/ Contrast","code_information":[{"code":"3750279","type":"CDM"},{"code":"0350","type":"RC"},{"code":"72126","type":"CPT"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":598.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Spine Cervical w/ + w/o Contrast","code_information":[{"code":"3750287","type":"CDM"},{"code":"0350","type":"RC"},{"code":"72127","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Spine Thoracic w/o Contrast","code_information":[{"code":"3750295","type":"CDM"},{"code":"0350","type":"RC"},{"code":"72128","type":"CPT"}],"standard_charges":[{"gross_charge":864.0,"discounted_cash":604.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Spine Thoracic w/ Contrast","code_information":[{"code":"3750303","type":"CDM"},{"code":"0350","type":"RC"},{"code":"72129","type":"CPT"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":598.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Spine Thoracic w/ + w/o Contrast","code_information":[{"code":"3750311","type":"CDM"},{"code":"0350","type":"RC"},{"code":"72130","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Spine Lumbar w/o Contrast","code_information":[{"code":"3750329","type":"CDM"},{"code":"0350","type":"RC"},{"code":"72131","type":"CPT"}],"standard_charges":[{"gross_charge":1628.0,"discounted_cash":1139.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Spine Lumbar w/ Contrast","code_information":[{"code":"3750337","type":"CDM"},{"code":"0350","type":"RC"},{"code":"72132","type":"CPT"}],"standard_charges":[{"gross_charge":1920.0,"discounted_cash":1344.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Spine Lumbar w/ + w/o Contrast","code_information":[{"code":"3750345","type":"CDM"},{"code":"0350","type":"RC"},{"code":"72133","type":"CPT"}],"standard_charges":[{"gross_charge":1078.0,"discounted_cash":754.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Pelvis w/ + w/o Contrast","code_information":[{"code":"3750352","type":"CDM"},{"code":"0350","type":"RC"},{"code":"72194","type":"CPT"}],"standard_charges":[{"gross_charge":1862.0,"discounted_cash":1303.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Wrist w/ + w/o Contrast Right","code_information":[{"code":"3750360","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73202","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Wrist w/ + w/o Contrast Left","code_information":[{"code":"3750360","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73202","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Shoulder w/ + w/o Contrast Right","code_information":[{"code":"3750360","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73202","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Shoulder w/ + w/o Contrast Left","code_information":[{"code":"3750360","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73202","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Humerus w/ + w/o Contrast Right","code_information":[{"code":"3750360","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73202","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Elbow w/ + w/o Contrast Left","code_information":[{"code":"3750360","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73202","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Hand w/ + w/o Contrast Right","code_information":[{"code":"3750360","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73202","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Hand w/ + w/o Contrast Left","code_information":[{"code":"3750360","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73202","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Forearm w/ + w/o Contrast Right","code_information":[{"code":"3750360","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73202","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Forearm w/ + w/o Contrast Left","code_information":[{"code":"3750360","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73202","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Elbow w/ + w/o Contrast Right","code_information":[{"code":"3750360","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73202","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Humerus w/ + w/o Contrast Left","code_information":[{"code":"3750360","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73202","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Femur w/ + w/o Contrast Right","code_information":[{"code":"3750378","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73702","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Tibia/Fibula w/ + w/o Contrast Right","code_information":[{"code":"3750378","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73702","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Tibia/Fibula w/ + w/o Contrast Left","code_information":[{"code":"3750378","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73702","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Knee w/ + w/o Contrast Right","code_information":[{"code":"3750378","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73702","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Knee w/ + w/o Contrast Left","code_information":[{"code":"3750378","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73702","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Hip w/ + w/o Contrast Right","code_information":[{"code":"3750378","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73702","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Foot w/ + w/o Contrast Right","code_information":[{"code":"3750378","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73702","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Hip w/ + w/o Contrast Left","code_information":[{"code":"3750378","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73702","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Femur w/ + w/o Contrast Left","code_information":[{"code":"3750378","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73702","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Ankle w/ + w/o Contrast Right","code_information":[{"code":"3750378","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73702","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Ankle w/ + w/o Contrast Left","code_information":[{"code":"3750378","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73702","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Foot w/ + w/o Contrast Left","code_information":[{"code":"3750378","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73702","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Orbits Sella w/ + w/o Contrast","code_information":[{"code":"3750394","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70482","type":"CPT"}],"standard_charges":[{"gross_charge":1078.0,"discounted_cash":754.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Neck w/ Cont","code_information":[{"code":"3750402","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70491","type":"CPT"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":598.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Neck Soft Tissue w/ Contrast","code_information":[{"code":"3750402","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70491","type":"CPT"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":598.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Neck Soft Tissue w/ + w/o Contrast","code_information":[{"code":"3750410","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70492","type":"CPT"}],"standard_charges":[{"gross_charge":1941.0,"discounted_cash":1358.7,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Neck w/ + w/o Cont","code_information":[{"code":"3750410","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70492","type":"CPT"}],"standard_charges":[{"gross_charge":1941.0,"discounted_cash":1358.7,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Orbits Sella w/ Contrast","code_information":[{"code":"3750436","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70481","type":"CPT"}],"standard_charges":[{"gross_charge":872.0,"discounted_cash":610.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Maxillofacial w/o Contrast","code_information":[{"code":"3750444","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70486","type":"CPT"}],"standard_charges":[{"gross_charge":1444.0,"discounted_cash":1010.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Maxillofacial w/ Contrast","code_information":[{"code":"3750451","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70487","type":"CPT"}],"standard_charges":[{"gross_charge":863.0,"discounted_cash":604.1,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Maxillofacial w/ + w/o Contrast","code_information":[{"code":"3750469","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70488","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Angio Head/Neck","code_information":[{"code":"3750471","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70471","type":"CPT"}],"standard_charges":[{"gross_charge":1094.0,"discounted_cash":765.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price"}]},{"description":"CT Angio Chest","code_information":[{"code":"3750545","type":"CDM"},{"code":"0350","type":"RC"},{"code":"71275","type":"CPT"}],"standard_charges":[{"gross_charge":1767.0,"discounted_cash":1236.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Renal Stone Study","code_information":[{"code":"3750555","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74176","type":"CPT"}],"standard_charges":[{"gross_charge":2045.0,"discounted_cash":1431.5,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Angio Brain/Head","code_information":[{"code":"3750557","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70496","type":"CPT"}],"standard_charges":[{"gross_charge":2327.0,"discounted_cash":1628.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"NORT CT Angio Neck","code_information":[{"code":"3750558","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70498","type":"CPT"}],"standard_charges":[{"gross_charge":2611.0,"discounted_cash":1827.7,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Angio Neck","code_information":[{"code":"3750558","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70498","type":"CPT"}],"standard_charges":[{"gross_charge":2611.0,"discounted_cash":1827.7,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Angio Pelvis","code_information":[{"code":"3750559","type":"CDM"},{"code":"0350","type":"RC"},{"code":"72191","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Angio Upper Extremity Left","code_information":[{"code":"3750560","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73206","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Angio Upper Extremity Right","code_information":[{"code":"3750560","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73206","type":"CPT"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Angio Lower Extremity Left","code_information":[{"code":"3750561","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73706","type":"CPT"}],"standard_charges":[{"gross_charge":2500.0,"discounted_cash":1750.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Angio Lower Extremity Right","code_information":[{"code":"3750561","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73706","type":"CPT"}],"standard_charges":[{"gross_charge":2500.0,"discounted_cash":1750.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Angio Abdomen and Pelvis","code_information":[{"code":"3750562","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74174","type":"CPT"}],"standard_charges":[{"gross_charge":2506.0,"discounted_cash":1754.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Angio Abdomen","code_information":[{"code":"3750563","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74175","type":"CPT"}],"standard_charges":[{"gross_charge":2841.0,"discounted_cash":1988.7,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CT Angio Abdominal Aorta with Runoff","code_information":[{"code":"3750564","type":"CDM"},{"code":"0350","type":"RC"},{"code":"75635","type":"CPT"}],"standard_charges":[{"gross_charge":2807.0,"discounted_cash":1964.9,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"76942 US GUIDED NEEDLE PLACMENT ProFee","code_information":[{"code":"376942","type":"CDM"},{"code":"0982","type":"RC"},{"code":"76942","type":"CPT"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":331.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_ProFee_Price"}]},{"description":"77080 DEXA SCAN INTERP ProFee","code_information":[{"code":"377080","type":"CDM"},{"code":"0982","type":"RC"},{"code":"77080","type":"CPT"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":214.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_ProFee_Price"}]},{"description":"US Retroperitoneal Limited","code_information":[{"code":"3776775","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76775","type":"CPT"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":233.1,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR Placement CVAD w/ Fluoro","code_information":[{"code":"3777001","type":"CDM"},{"code":"0402","type":"RC"},{"code":"77001","type":"CPT"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NORT_Hosp_Tech_Price"}]},{"description":"THP pantoprazole 40 mg Tab #4 {NORT}","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"3800001","type":"CDM"},{"code":"99999-9999-33","type":"NDC"}],"standard_charges":[{"gross_charge":6.83,"discounted_cash":4.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THP prednisoLONE 45mg/15 mL UD [NORT]","drug_information":{"unit":15.0,"type":"EA"},"code_information":[{"code":"3800002","type":"CDM"},{"code":"J7510","type":"HCPCS"},{"code":"00121-0759-08-THP","type":"NDC"}],"standard_charges":[{"gross_charge":71.23,"discounted_cash":49.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamcinolone topical 0.1% Oin [NORT]","drug_information":{"unit":15.0,"type":"EA"},"code_information":[{"code":"38000025","type":"CDM"},{"code":"21922-0063-04","type":"NDC"}],"standard_charges":[{"gross_charge":20.66,"discounted_cash":14.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamcinolone Top 0.1% Oint 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3200]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3200]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Age 0-17","code_information":[{"code":"396","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3200]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3200]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3200]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3200]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3200]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w other O.R. proc w CC","code_information":[{"code":"401","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3200]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other heart assist system implant","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3200]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"526","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: Fee Schedule]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3200]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"527","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"38","median_amount":86.11,"10th_percentile":45.94,"90th_percentile":126.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"419","median_amount":86.17,"10th_percentile":73.24,"90th_percentile":122.08},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"244","median_amount":79.6,"10th_percentile":44.6,"90th_percentile":133.0}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":444.7,"10th_percentile":444.7,"90th_percentile":444.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":933.52,"10th_percentile":933.52,"90th_percentile":933.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"38","median_amount":581.61,"10th_percentile":273.42,"90th_percentile":1294.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":224.22,"10th_percentile":141.7,"90th_percentile":673.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":480.6,"10th_percentile":393.93,"90th_percentile":932.3},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":182.82,"10th_percentile":182.82,"90th_percentile":182.82}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"19","median_amount":600.0,"10th_percentile":389.52,"90th_percentile":968.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"122","median_amount":859.75,"10th_percentile":325.66,"90th_percentile":1751.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":873.56,"10th_percentile":873.56,"90th_percentile":873.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"28","median_amount":400.41,"10th_percentile":214.4,"90th_percentile":695.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":1506.11,"10th_percentile":767.81,"90th_percentile":1588.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"17","median_amount":749.66,"10th_percentile":376.2,"90th_percentile":1140.62},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"14","median_amount":1157.92,"10th_percentile":221.29,"90th_percentile":2231.11}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":1688.55,"10th_percentile":1688.55,"90th_percentile":1688.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":4939.43,"10th_percentile":4939.43,"90th_percentile":4939.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"26","median_amount":1194.21,"10th_percentile":616.01,"90th_percentile":2535.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"154","median_amount":1803.33,"10th_percentile":784.85,"90th_percentile":3260.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":3165.57,"10th_percentile":3165.57,"90th_percentile":3165.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"21","median_amount":558.21,"10th_percentile":345.98,"90th_percentile":887.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"14","median_amount":1372.59,"10th_percentile":262.3,"90th_percentile":3201.17},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"11","median_amount":1133.18,"10th_percentile":228.59,"90th_percentile":3197.54}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":3858.08,"10th_percentile":3858.08,"90th_percentile":3858.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":1727.15,"10th_percentile":1727.15,"90th_percentile":3434.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"14","median_amount":2097.15,"10th_percentile":1372.01,"90th_percentile":5323.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"59","median_amount":2822.77,"10th_percentile":1685.17,"90th_percentile":5998.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":4564.5,"10th_percentile":4564.5,"90th_percentile":4564.5},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":3768.04,"10th_percentile":3768.04,"90th_percentile":3768.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":936.19,"10th_percentile":519.79,"90th_percentile":1917.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":2110.27,"10th_percentile":2110.27,"90th_percentile":2110.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1766.75,"10th_percentile":1766.75,"90th_percentile":5058.4},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":3661.68,"10th_percentile":2209.31,"90th_percentile":6292.75}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":5232.72,"10th_percentile":5232.72,"90th_percentile":5232.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":5685.31,"10th_percentile":2832.21,"90th_percentile":12981.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":128.1,"10th_percentile":128.1,"90th_percentile":128.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"35","median_amount":183.4,"10th_percentile":89.51,"90th_percentile":244.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":221.64,"10th_percentile":221.64,"90th_percentile":221.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":289.01,"10th_percentile":289.01,"90th_percentile":289.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":198.57,"10th_percentile":166.75,"90th_percentile":198.57},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":112.26,"10th_percentile":112.26,"90th_percentile":161.2}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":293.58,"10th_percentile":279.4,"90th_percentile":440.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":157.43,"10th_percentile":157.43,"90th_percentile":157.43},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":164.14,"10th_percentile":164.14,"90th_percentile":164.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":457.0,"10th_percentile":457.0,"90th_percentile":457.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":113.34,"10th_percentile":113.34,"90th_percentile":113.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":5255.36,"10th_percentile":5255.36,"90th_percentile":5255.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":3137.5,"10th_percentile":3137.5,"90th_percentile":3137.5},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":3363.98,"10th_percentile":3363.98,"90th_percentile":3363.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":1804.23,"10th_percentile":1573.75,"90th_percentile":2891.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":223.59,"10th_percentile":223.59,"90th_percentile":223.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1812.95,"10th_percentile":1812.95,"90th_percentile":1812.95},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":2708.85,"10th_percentile":2708.85,"90th_percentile":2708.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":2539.06,"10th_percentile":2258.29,"90th_percentile":3074.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":1193.52,"10th_percentile":1193.52,"90th_percentile":1193.52}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":2953.32,"10th_percentile":2953.32,"90th_percentile":2953.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"28","median_amount":2731.52,"10th_percentile":2229.58,"90th_percentile":3081.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":3369.79,"10th_percentile":3369.79,"90th_percentile":3369.79},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":4532.26,"10th_percentile":4532.26,"90th_percentile":4532.26}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":3145.01,"10th_percentile":3145.01,"90th_percentile":3603.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"14","median_amount":2853.82,"10th_percentile":2676.22,"90th_percentile":3419.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":3147.82,"10th_percentile":3147.82,"90th_percentile":3147.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":1290.49,"10th_percentile":1290.49,"90th_percentile":1290.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":4202.73,"10th_percentile":4202.73,"90th_percentile":4202.73},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Gynecologic Procedures","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":477.51,"10th_percentile":477.51,"90th_percentile":477.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":222.39,"10th_percentile":222.39,"90th_percentile":222.39},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Gynecologic Procedures","code_information":[{"code":"5412","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":313.98,"10th_percentile":313.98,"90th_percentile":313.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":9985.93,"10th_percentile":9985.93,"90th_percentile":10144.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":2844.36,"10th_percentile":2844.36,"90th_percentile":2844.36}]}]},{"description":"Level 2 Nerve Procedures","code_information":[{"code":"5432","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":205.1,"10th_percentile":205.1,"90th_percentile":7765.81},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"11","median_amount":56.23,"10th_percentile":44.34,"90th_percentile":116.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"60","median_amount":100.52,"10th_percentile":25.0,"90th_percentile":576.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":217.28,"10th_percentile":54.37,"90th_percentile":237.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":289.01,"10th_percentile":289.01,"90th_percentile":289.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":80.48,"10th_percentile":80.48,"90th_percentile":80.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":65.86,"10th_percentile":65.65,"90th_percentile":3252.2},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":61.42,"10th_percentile":25.03,"90th_percentile":93.33}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":1766.82,"10th_percentile":1658.92,"90th_percentile":2208.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"12","median_amount":1652.48,"10th_percentile":1286.95,"90th_percentile":1965.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":1185.94,"10th_percentile":1185.94,"90th_percentile":1185.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":8258.53,"10th_percentile":8258.53,"90th_percentile":8258.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":4121.82,"10th_percentile":4121.82,"90th_percentile":4121.82}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":613.8,"10th_percentile":433.8,"90th_percentile":1980.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":701.46,"10th_percentile":701.46,"90th_percentile":701.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"30","median_amount":208.3,"10th_percentile":101.57,"90th_percentile":540.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"237","median_amount":198.71,"10th_percentile":131.58,"90th_percentile":502.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":198.71,"10th_percentile":198.0,"90th_percentile":519.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"18","median_amount":137.14,"10th_percentile":131.58,"90th_percentile":506.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":155.85,"10th_percentile":27.5,"90th_percentile":301.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"42","median_amount":245.0,"10th_percentile":174.3,"90th_percentile":463.64},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"12","median_amount":429.4,"10th_percentile":294.5,"90th_percentile":937.56}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":799.2,"10th_percentile":799.2,"90th_percentile":799.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":799.2,"10th_percentile":492.3,"90th_percentile":1465.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"23","median_amount":346.3,"10th_percentile":273.24,"90th_percentile":692.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"258","median_amount":325.88,"10th_percentile":137.53,"90th_percentile":766.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":738.15,"10th_percentile":738.15,"90th_percentile":738.15},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":342.95,"10th_percentile":342.95,"90th_percentile":342.95},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":630.89,"10th_percentile":199.9,"90th_percentile":630.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"14","median_amount":165.15,"10th_percentile":106.83,"90th_percentile":268.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":799.2,"10th_percentile":799.2,"90th_percentile":799.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"20","median_amount":408.8,"10th_percentile":197.4,"90th_percentile":808.64},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"21","median_amount":667.85,"10th_percentile":80.0,"90th_percentile":1367.05}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"13","median_amount":681.2,"10th_percentile":577.81,"90th_percentile":1802.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"133","median_amount":725.64,"10th_percentile":302.91,"90th_percentile":1545.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":938.52,"10th_percentile":938.52,"90th_percentile":938.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"13","median_amount":233.4,"10th_percentile":233.4,"90th_percentile":353.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":1167.3,"10th_percentile":1167.3,"90th_percentile":6465.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"14","median_amount":825.69,"10th_percentile":665.7,"90th_percentile":991.9},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":1232.15,"10th_percentile":985.72,"90th_percentile":2894.65}]}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":2803.5,"10th_percentile":2803.5,"90th_percentile":2803.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":1496.05,"10th_percentile":1113.14,"90th_percentile":1850.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"53","median_amount":2062.75,"10th_percentile":1353.73,"90th_percentile":2501.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":2062.75,"10th_percentile":2062.75,"90th_percentile":2317.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":225.46,"10th_percentile":225.46,"90th_percentile":303.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1810.95,"10th_percentile":498.43,"90th_percentile":1847.31},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":2347.45,"10th_percentile":2347.45,"90th_percentile":3023.52}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":3243.06,"10th_percentile":3243.06,"90th_percentile":3243.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":2570.97,"10th_percentile":2570.97,"90th_percentile":2570.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"26","median_amount":1193.57,"10th_percentile":859.65,"90th_percentile":1931.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":1336.74,"10th_percentile":1336.74,"90th_percentile":1743.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1681.75,"10th_percentile":777.84,"90th_percentile":2299.27},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":2182.03,"10th_percentile":2182.03,"90th_percentile":2920.78}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":2583.45,"10th_percentile":2583.45,"90th_percentile":2583.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":1360.54,"10th_percentile":932.87,"90th_percentile":4554.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"37","median_amount":1154.55,"10th_percentile":914.93,"90th_percentile":2634.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":1079.22,"10th_percentile":1079.22,"90th_percentile":1079.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":368.26,"10th_percentile":368.26,"90th_percentile":368.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1345.4,"10th_percentile":1161.17,"90th_percentile":2143.75},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":1346.15,"10th_percentile":1346.15,"90th_percentile":1346.15}]}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":1455.3,"10th_percentile":1455.3,"90th_percentile":1455.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":580.14,"10th_percentile":580.14,"90th_percentile":580.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":3705.42,"10th_percentile":3705.42,"90th_percentile":3705.42}]}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"23","median_amount":3019.61,"10th_percentile":2495.85,"90th_percentile":3098.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":2056.52,"10th_percentile":2056.52,"90th_percentile":2056.52},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":2729.2,"10th_percentile":1943.09,"90th_percentile":3757.14},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":3288.89,"10th_percentile":3288.89,"90th_percentile":3288.89}]}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":159.72,"10th_percentile":147.08,"90th_percentile":192.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":901.21,"10th_percentile":901.21,"90th_percentile":901.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":3626.84,"10th_percentile":3491.67,"90th_percentile":4284.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"228","median_amount":19.62,"10th_percentile":16.25,"90th_percentile":23.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"132","median_amount":10.74,"10th_percentile":8.81,"90th_percentile":10.74},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":10.49,"10th_percentile":10.49,"90th_percentile":10.49}]}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":105.52,"10th_percentile":101.34,"90th_percentile":127.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"76","median_amount":82.42,"10th_percentile":24.1,"90th_percentile":169.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"618","median_amount":77.27,"10th_percentile":30.16,"90th_percentile":149.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":254.83,"10th_percentile":254.83,"90th_percentile":254.83},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"17","median_amount":112.02,"10th_percentile":94.29,"90th_percentile":203.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"25","median_amount":289.01,"10th_percentile":289.01,"90th_percentile":305.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"13","median_amount":64.69,"10th_percentile":31.67,"90th_percentile":155.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"137","median_amount":35.0,"10th_percentile":14.39,"90th_percentile":149.53},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"30","median_amount":110.12,"10th_percentile":15.71,"90th_percentile":213.55}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"18","median_amount":1327.27,"10th_percentile":389.07,"90th_percentile":19629.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"113","median_amount":882.97,"10th_percentile":341.73,"90th_percentile":6097.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":502.36,"10th_percentile":502.36,"90th_percentile":502.36},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":617.98,"10th_percentile":566.21,"90th_percentile":785.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":759.54,"10th_percentile":455.98,"90th_percentile":1091.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":1764.0,"10th_percentile":1764.0,"90th_percentile":1764.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"17","median_amount":496.0,"10th_percentile":420.55,"90th_percentile":864.63},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":505.87,"10th_percentile":505.87,"90th_percentile":505.87}]}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":441.53,"10th_percentile":441.53,"90th_percentile":441.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"12","median_amount":271.6,"10th_percentile":270.62,"90th_percentile":351.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":270.62,"10th_percentile":270.62,"90th_percentile":270.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":616.5,"10th_percentile":616.5,"90th_percentile":616.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":223.25,"10th_percentile":223.25,"90th_percentile":223.25},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":455.05,"10th_percentile":455.05,"90th_percentile":455.05}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":1044.26,"10th_percentile":1044.26,"90th_percentile":1044.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":881.43,"10th_percentile":490.99,"90th_percentile":1048.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":1037.13,"10th_percentile":1037.13,"90th_percentile":1037.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1230.6,"10th_percentile":706.07,"90th_percentile":2159.4},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":1220.1,"10th_percentile":1220.1,"90th_percentile":1220.1}]}]},{"description":"Level 4 Diagnostic Tests and Related Services","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":4633.2,"10th_percentile":4633.2,"90th_percentile":4633.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"18","median_amount":1387.59,"10th_percentile":1110.07,"90th_percentile":1387.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":1387.59,"10th_percentile":1387.59,"90th_percentile":1387.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":1508.65,"10th_percentile":1508.65,"90th_percentile":1508.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":3198.24,"10th_percentile":3198.24,"90th_percentile":3198.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":924.85,"10th_percentile":924.85,"90th_percentile":924.85},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Minor Procedures","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":4.34,"10th_percentile":4.34,"90th_percentile":4.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":154.66,"10th_percentile":154.66,"90th_percentile":154.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":924.0,"10th_percentile":924.0,"90th_percentile":924.0},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Minor Procedures","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":459.65,"10th_percentile":459.65,"90th_percentile":459.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"21","median_amount":247.3,"10th_percentile":197.84,"90th_percentile":370.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":39.2,"10th_percentile":39.2,"90th_percentile":39.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":306.9,"10th_percentile":243.72,"90th_percentile":477.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"69","median_amount":266.38,"10th_percentile":213.49,"90th_percentile":339.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":276.05,"10th_percentile":276.05,"90th_percentile":276.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":37.17,"10th_percentile":37.17,"90th_percentile":1342.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":300.0,"10th_percentile":262.5,"90th_percentile":527.48},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":437.0,"10th_percentile":356.25,"90th_percentile":758.0}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":1349.01,"10th_percentile":1349.01,"90th_percentile":1349.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"13","median_amount":543.73,"10th_percentile":243.07,"90th_percentile":1566.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":276.63,"10th_percentile":276.63,"90th_percentile":276.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":198.44,"10th_percentile":182.57,"90th_percentile":580.64},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":1296.64,"10th_percentile":1190.97,"90th_percentile":1379.85}]}]},{"description":"Level 5 Minor Procedures","code_information":[{"code":"5735","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":200.61,"10th_percentile":200.61,"90th_percentile":200.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":948.75,"10th_percentile":948.75,"90th_percentile":948.75},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Rehabilitation","code_information":[{"code":"5771","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":3083.4,"10th_percentile":1884.3,"90th_percentile":3083.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":2089.05,"10th_percentile":2089.05,"90th_percentile":2089.05}]}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":1472.9,"10th_percentile":1472.9,"90th_percentile":1472.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":199.19,"10th_percentile":199.19,"90th_percentile":765.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Health and Behavior Services","code_information":[{"code":"5822","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":166.0,"10th_percentile":166.0,"90th_percentile":166.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, bupivacaine, nos, 0.5mg","code_information":[{"code":"9290","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":88.77,"10th_percentile":88.77,"90th_percentile":88.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-OPPS Clinic Services","code_information":[{"code":"N700","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":73.83,"10th_percentile":73.83,"90th_percentile":94.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"23","median_amount":99.67,"10th_percentile":62.76,"90th_percentile":178.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":75.94,"10th_percentile":75.94,"90th_percentile":75.94},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"284","median_amount":83.36,"10th_percentile":70.86,"90th_percentile":117.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"2719","median_amount":102.28,"10th_percentile":54.46,"90th_percentile":162.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":137.0,"10th_percentile":119.7,"90th_percentile":299.13},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"45","median_amount":114.46,"10th_percentile":62.63,"90th_percentile":170.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"289","median_amount":289.01,"10th_percentile":289.01,"90th_percentile":299.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"36","median_amount":86.11,"10th_percentile":45.94,"90th_percentile":126.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"409","median_amount":86.17,"10th_percentile":73.24,"90th_percentile":122.08},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"230","median_amount":79.6,"10th_percentile":44.6,"90th_percentile":115.58}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":184.0,"10th_percentile":134.1,"90th_percentile":205.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":143.12,"10th_percentile":92.34,"90th_percentile":347.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":79.87,"10th_percentile":79.87,"90th_percentile":79.87},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"147","median_amount":146.13,"10th_percentile":38.02,"90th_percentile":415.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1143","median_amount":102.37,"10th_percentile":33.38,"90th_percentile":307.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":483.55,"10th_percentile":483.55,"90th_percentile":483.55},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"46","median_amount":63.2,"10th_percentile":36.9,"90th_percentile":191.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"68","median_amount":61.43,"10th_percentile":17.66,"90th_percentile":295.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"15","median_amount":123.52,"10th_percentile":46.8,"90th_percentile":393.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"178","median_amount":175.7,"10th_percentile":57.4,"90th_percentile":367.5},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"73","median_amount":273.6,"10th_percentile":85.21,"90th_percentile":610.75}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":2247.03,"10th_percentile":2247.03,"90th_percentile":2247.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"19","median_amount":434.21,"10th_percentile":230.47,"90th_percentile":2147.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"164","median_amount":1161.47,"10th_percentile":256.95,"90th_percentile":2864.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":453.48,"10th_percentile":327.24,"90th_percentile":4710.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"15","median_amount":1388.8,"10th_percentile":271.6,"90th_percentile":2256.41},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":870.48,"10th_percentile":483.46,"90th_percentile":5344.7}]}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":251.1,"10th_percentile":251.1,"90th_percentile":251.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":491.15,"10th_percentile":491.15,"90th_percentile":491.15},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":316.67,"10th_percentile":162.39,"90th_percentile":316.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":465.3,"10th_percentile":465.3,"90th_percentile":465.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":361.9,"10th_percentile":361.9,"90th_percentile":361.9},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":265.05,"10th_percentile":265.05,"90th_percentile":491.15}]}]},{"description":"Other Medicine","code_information":[{"code":"N809","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":275.18,"10th_percentile":275.18,"90th_percentile":275.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":105.38,"10th_percentile":105.38,"90th_percentile":105.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"29","median_amount":96.76,"10th_percentile":96.76,"90th_percentile":146.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"248","median_amount":182.57,"10th_percentile":166.8,"90th_percentile":234.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":204.0,"10th_percentile":204.0,"90th_percentile":204.0},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":182.57,"10th_percentile":182.57,"90th_percentile":182.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"20","median_amount":289.01,"10th_percentile":289.01,"90th_percentile":289.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":105.38,"10th_percentile":99.14,"90th_percentile":105.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"19","median_amount":133.78,"10th_percentile":113.71,"90th_percentile":156.74},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"16","median_amount":136.2,"10th_percentile":127.82,"90th_percentile":138.73}]}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":413.73,"10th_percentile":198.25,"90th_percentile":638.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":106.46,"10th_percentile":106.46,"90th_percentile":106.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":343.0,"10th_percentile":343.0,"90th_percentile":343.0},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":115.58,"10th_percentile":115.58,"90th_percentile":115.58}]}]},{"description":"Influenza Vaccines & Pneumococcal Pneumonia Vaccines","code_information":[{"code":"N903","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":192.09,"10th_percentile":135.67,"90th_percentile":256.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":113.55,"10th_percentile":113.55,"90th_percentile":113.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":147.07,"10th_percentile":147.07,"90th_percentile":147.07}]}]},{"description":"Not Recognized by OPPS","code_information":[{"code":"N905","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"1 through 10","median_amount":18.82,"10th_percentile":18.82,"90th_percentile":18.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"1 through 10","median_amount":47.37,"10th_percentile":1.62,"90th_percentile":100.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[OP Fee Schedule Rate: 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.kancare.ks.gov/home/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain Health","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Observation-Per Hour: 63] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":89.44,"10th_percentile":89.44,"90th_percentile":89.44},{"payer_name":"United Healthcare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]}],"modifier_information":[{"description":"Bilateral Procedure","code":"50","modifier_payer_information":[{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Crna service: without medical direction by a physician","code":"QZ","modifier_payer_information":[{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Bcbs","plan_name":"All 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price is presented in the standard charge value."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Non-physician (e.g. nurse practitioner (np), certified registered nurse anesthetist (crna), certified registered nurse (crn), clinical nurse specialist (cns), physician assistant (pa)) services in a critical access hospital","code":"GF","modifier_payer_information":[{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Reference (Outside) Laboratory","code":"90","modifier_payer_information":[{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Clia waived test","code":"QW","modifier_payer_information":[{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Assistant Surgeon","code":"80","modifier_payer_information":[{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Left side (used to identify procedures performed on the left side of the body)","code":"LT","modifier_payer_information":[{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Right side (used to identify procedures performed on the right side of the body)","code":"RT","modifier_payer_information":[{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant","code":"CQ","modifier_payer_information":[{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System","code":"95","modifier_payer_information":[{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Policy criteria applied","code":"CG","modifier_payer_information":[{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the same day of the Procedure or Other Service","code":"25","modifier_payer_information":[{"payer_name":"Bcbs Of Kansas","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Bcbs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Sunflower Health Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providrs Care Network","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Life Ins Company","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allied Benefit Systems","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Blue Kancare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]}]}