{ "hospital_name": "St. Mary’s General Hospital", "last_updated_on": "2025-12-09","version": "2.2.0", "hospital_location": ["St. Mary’s General Hospital"],"hospital_address": [ "350 Boulevard Passaic, NJ 07055" ], "license_information": { "license_number": "463499370", "state": "NJ" }, "affirmation": { "affirmation": "To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.", "confirm_affirmation": true } , "standard_charge_information": [ { "description": "Hc Pfizer-Biontech Covid-19 Vaccine Administration – First Dose", "code_information": [ { "code": "0001A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.46,"maximum": 34,"payers_information":[{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 8.8, "standard_charge_percentage": 22.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8, "standard_charge_percentage": 20.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 7.61, "standard_charge_percentage": 19.0200, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 31.36, "standard_charge_percentage": 78.4000, "estimated_amount": 31, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8.8, "standard_charge_percentage": 22.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 10, "standard_charge_percentage": 25.0000, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 24, "standard_charge_percentage": 60.0000, "estimated_amount": 24, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 10, "standard_charge_percentage": 25.0000, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 7.46, "standard_charge_percentage": 18.6500, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 31.36, "standard_charge_percentage": 78.4000, "estimated_amount": 31, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "estimated_amount": 12, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Pfizer-Biontech Covid-19 Vaccine Administration – Second Dose", "code_information": [ { "code": "0002A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.46,"maximum": 34,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 24, "standard_charge_percentage": 60.0000, "estimated_amount": 24, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 7.46, "standard_charge_percentage": 18.6500, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "estimated_amount": 12, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 31.36, "standard_charge_percentage": 78.4000, "estimated_amount": 31, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 31.36, "standard_charge_percentage": 78.4000, "estimated_amount": 31, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8.8, "standard_charge_percentage": 22.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 8.8, "standard_charge_percentage": 22.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8, "standard_charge_percentage": 20.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 10, "standard_charge_percentage": 25.0000, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 10, "standard_charge_percentage": 25.0000, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 7.61, "standard_charge_percentage": 19.0200, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Pfizer-Biontech Covid-19 Vaccine Administration – Third Dose", "code_information": [ { "code": "0003A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.46,"maximum": 34,"payers_information":[{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 8.8, "standard_charge_percentage": 22.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 10, "standard_charge_percentage": 25.0000, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 7.46, "standard_charge_percentage": 18.6500, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 7.61, "standard_charge_percentage": 19.0200, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "estimated_amount": 12, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 31.36, "standard_charge_percentage": 78.4000, "estimated_amount": 31, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 10, "standard_charge_percentage": 25.0000, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 24, "standard_charge_percentage": 60.0000, "estimated_amount": 24, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8.8, "standard_charge_percentage": 22.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8, "standard_charge_percentage": 20.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 31.36, "standard_charge_percentage": 78.4000, "estimated_amount": 31, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Liver Dis 10 Assays W/Nash", "code_information": [ { "code": "0003M", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2517, "discounted_cash": 654,"minimum": 402.72,"maximum": 2139.45,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1973.33, "standard_charge_percentage": 78.4000, "estimated_amount": 1973, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 503.4, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 503.4, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 704.76, "estimated_amount": 704, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1006.8, "estimated_amount": 1006, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 2139.45, "standard_charge_percentage": 85.0000, "estimated_amount": 2139, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 478.81, "standard_charge_percentage": 19.0200, "estimated_amount": 478, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 492.83, "standard_charge_percentage": 19.5800, "estimated_amount": 492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1258.5, "standard_charge_percentage": 50.0000, "estimated_amount": 1258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 503.4, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 679.59, "estimated_amount": 679, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 503.4, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1006.8, "estimated_amount": 1006, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 503.4, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1067.21, "estimated_amount": 1067, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1067.21, "estimated_amount": 1067, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2013.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 755.1, "standard_charge_percentage": 30.0000, "estimated_amount": 755, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2013.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 503.4, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1777, "estimated_amount": 1777, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1777, "estimated_amount": 1777, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 604.08, "estimated_amount": 604, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 503.4, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 729.93, "estimated_amount": 729, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 528.57, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 469.42, "standard_charge_percentage": 18.6500, "estimated_amount": 469, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 2139.45, "standard_charge_percentage": 85.0000, "estimated_amount": 2139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1973.33, "standard_charge_percentage": 78.4000, "estimated_amount": 1973, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 402.72, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 503.4, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1777, "estimated_amount": 1777, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 503.4, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 503.4, "estimated_amount": 503, "methodology": "fee schedule" }]}]} , { "description": "Hc Pfizer-Biontech Covid-19 Vaccine Administration – Booster Dose", "code_information": [ { "code": "0004A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.46,"maximum": 34,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8, "standard_charge_percentage": 20.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 10, "standard_charge_percentage": 25.0000, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 10, "standard_charge_percentage": 25.0000, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 7.46, "standard_charge_percentage": 18.6500, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "estimated_amount": 12, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 31.36, "standard_charge_percentage": 78.4000, "estimated_amount": 31, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 24, "standard_charge_percentage": 60.0000, "estimated_amount": 24, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 7.61, "standard_charge_percentage": 19.0200, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8.8, "standard_charge_percentage": 22.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 8.8, "standard_charge_percentage": 22.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 31.36, "standard_charge_percentage": 78.4000, "estimated_amount": 31, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Moderna Covid-19 Vaccine Administration – First Dose", "code_information": [ { "code": "0011A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.46,"maximum": 34,"payers_information":[{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 8.8, "standard_charge_percentage": 22.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8, "standard_charge_percentage": 20.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 10, "standard_charge_percentage": 25.0000, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 7.61, "standard_charge_percentage": 19.0200, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "estimated_amount": 12, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 31.36, "standard_charge_percentage": 78.4000, "estimated_amount": 31, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 10, "standard_charge_percentage": 25.0000, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8.8, "standard_charge_percentage": 22.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 24, "standard_charge_percentage": 60.0000, "estimated_amount": 24, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 7.46, "standard_charge_percentage": 18.6500, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 31.36, "standard_charge_percentage": 78.4000, "estimated_amount": 31, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Moderna Covid-19 Vaccine Administration – Second Dose", "code_information": [ { "code": "0012A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.46,"maximum": 34,"payers_information":[{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8.8, "standard_charge_percentage": 22.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 10, "standard_charge_percentage": 25.0000, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 7.46, "standard_charge_percentage": 18.6500, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 31.36, "standard_charge_percentage": 78.4000, "estimated_amount": 31, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 8.8, "standard_charge_percentage": 22.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 7.61, "standard_charge_percentage": 19.0200, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 10, "standard_charge_percentage": 25.0000, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 24, "standard_charge_percentage": 60.0000, "estimated_amount": 24, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 31.36, "standard_charge_percentage": 78.4000, "estimated_amount": 31, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8, "standard_charge_percentage": 20.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "estimated_amount": 12, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Moderna Covid-19 Vaccine Administration – Third Dose", "code_information": [ { "code": "0013A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.46,"maximum": 34,"payers_information":[{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8.8, "standard_charge_percentage": 22.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 10, "standard_charge_percentage": 25.0000, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 24, "standard_charge_percentage": 60.0000, "estimated_amount": 24, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 31.36, "standard_charge_percentage": 78.4000, "estimated_amount": 31, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8, "standard_charge_percentage": 20.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 8.8, "standard_charge_percentage": 22.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "estimated_amount": 12, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 10, "standard_charge_percentage": 25.0000, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 7.46, "standard_charge_percentage": 18.6500, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 7.61, "standard_charge_percentage": 19.0200, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 31.36, "standard_charge_percentage": 78.4000, "estimated_amount": 31, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" }]}]} , { "description": "Laboratory - Pathology", "code_information": [ { "code": "0014M", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 880.95, "discounted_cash": 229,"minimum": 140.95,"maximum": 748.81,"payers_information":[{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 176.19, "estimated_amount": 176, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 176.19, "estimated_amount": 176, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 140.95, "estimated_amount": 140, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 176.19, "estimated_amount": 176, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 303.22, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 748.81, "standard_charge_percentage": 85.0000, "estimated_amount": 748, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 748.81, "standard_charge_percentage": 85.0000, "estimated_amount": 748, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 440.48, "standard_charge_percentage": 50.0000, "estimated_amount": 440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 176.19, "estimated_amount": 176, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 237.86, "estimated_amount": 237, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 176.19, "estimated_amount": 176, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 303.22, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 352.38, "estimated_amount": 352, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 258.91, "estimated_amount": 258, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 176.19, "estimated_amount": 176, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 373.52, "estimated_amount": 373, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 167.58, "standard_charge_percentage": 19.0200, "estimated_amount": 167, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 704.76, "standard_charge_percentage": 80.0000, "estimated_amount": 704, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 690.66, "standard_charge_percentage": 78.4000, "estimated_amount": 690, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 704.76, "standard_charge_percentage": 80.0000, "estimated_amount": 704, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 176.19, "estimated_amount": 176, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 281.9, "estimated_amount": 281, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 352.38, "estimated_amount": 352, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 185, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 373.52, "estimated_amount": 373, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 164.3, "standard_charge_percentage": 18.6500, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 264.29, "standard_charge_percentage": 30.0000, "estimated_amount": 264, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 690.66, "standard_charge_percentage": 78.4000, "estimated_amount": 690, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 303.22, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 246.67, "estimated_amount": 246, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 176.19, "estimated_amount": 176, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 176.19, "estimated_amount": 176, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 176.19, "estimated_amount": 176, "methodology": "fee schedule" }]}]} , { "description": "Hc Astrazeneca Covid-19 Vaccine Administration – First Dose", "code_information": [ { "code": "0021A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.46,"maximum": 34,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 7.46, "standard_charge_percentage": 18.6500, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 31.36, "standard_charge_percentage": 78.4000, "estimated_amount": 31, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 24, "standard_charge_percentage": 60.0000, "estimated_amount": 24, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 7.61, "standard_charge_percentage": 19.0200, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 31.36, "standard_charge_percentage": 78.4000, "estimated_amount": 31, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "estimated_amount": 12, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Astrazeneca Covid-19 Vaccine Administration – Second Dose", "code_information": [ { "code": "0022A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.46,"maximum": 34,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 7.61, "standard_charge_percentage": 19.0200, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "estimated_amount": 12, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 31.36, "standard_charge_percentage": 78.4000, "estimated_amount": 31, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 7.46, "standard_charge_percentage": 18.6500, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 31.36, "standard_charge_percentage": 78.4000, "estimated_amount": 31, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 24, "standard_charge_percentage": 60.0000, "estimated_amount": 24, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Imm Admn Sarscov2 Ad26 5X1010 Vp/0.5 Ml 1 Dose", "code_information": [ { "code": "0031A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.46,"maximum": 34,"payers_information":[{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8.8, "standard_charge_percentage": 22.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 10, "standard_charge_percentage": 25.0000, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 24, "standard_charge_percentage": 60.0000, "estimated_amount": 24, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 31.36, "standard_charge_percentage": 78.4000, "estimated_amount": 31, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 8.8, "standard_charge_percentage": 22.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8, "standard_charge_percentage": 20.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "estimated_amount": 12, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 10, "standard_charge_percentage": 25.0000, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 7.46, "standard_charge_percentage": 18.6500, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 7.61, "standard_charge_percentage": 19.0200, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 31.36, "standard_charge_percentage": 78.4000, "estimated_amount": 31, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Johnson&Johnson Covid-19 Vaccine Administration - Booster Dose", "code_information": [ { "code": "0034A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.46,"maximum": 34,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 24, "standard_charge_percentage": 60.0000, "estimated_amount": 24, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 7.46, "standard_charge_percentage": 18.6500, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 31.36, "standard_charge_percentage": 78.4000, "estimated_amount": 31, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 10, "standard_charge_percentage": 25.0000, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 7.61, "standard_charge_percentage": 19.0200, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "estimated_amount": 12, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8.8, "standard_charge_percentage": 22.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 8.8, "standard_charge_percentage": 22.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8, "standard_charge_percentage": 20.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 10, "standard_charge_percentage": 25.0000, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 31.36, "standard_charge_percentage": 78.4000, "estimated_amount": 31, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Cerbral Perfusion Study, Ct W/ Contrast", "code_information": [ { "code": "0042T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3131,"minimum": 583.93,"maximum": 2661.35,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 595.61, "standard_charge_percentage": 19.0200, "estimated_amount": 595, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 939.3, "standard_charge_percentage": 30.0000, "estimated_amount": 939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1565.5, "standard_charge_percentage": 50.0000, "estimated_amount": 1565, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 2661.35, "standard_charge_percentage": 85.0000, "estimated_amount": 2661, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 2661.35, "standard_charge_percentage": 85.0000, "estimated_amount": 2661, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2504.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 613.05, "standard_charge_percentage": 19.5800, "estimated_amount": 613, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2504.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 583.93, "standard_charge_percentage": 18.6500, "estimated_amount": 583, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 2454.7, "standard_charge_percentage": 78.4000, "estimated_amount": 2454, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 2454.7, "standard_charge_percentage": 78.4000, "estimated_amount": 2454, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Moderna Covid-19 Vaccine Administration – Booster Dose", "code_information": [ { "code": "0064A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.46,"maximum": 34,"payers_information":[{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8.8, "standard_charge_percentage": 22.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 10, "standard_charge_percentage": 25.0000, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 7.46, "standard_charge_percentage": 18.6500, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 31.36, "standard_charge_percentage": 78.4000, "estimated_amount": 31, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 24, "standard_charge_percentage": 60.0000, "estimated_amount": 24, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 10, "standard_charge_percentage": 25.0000, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 7.61, "standard_charge_percentage": 19.0200, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 31.36, "standard_charge_percentage": 78.4000, "estimated_amount": 31, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 8.8, "standard_charge_percentage": 22.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8, "standard_charge_percentage": 20.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "estimated_amount": 12, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "00731", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 689,"minimum": 128.5,"maximum": 585.65,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 128.5, "standard_charge_percentage": 18.6500, "estimated_amount": 128, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 131.07, "standard_charge_percentage": 19.0200, "estimated_amount": 131, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 206.7, "standard_charge_percentage": 30.0000, "estimated_amount": 206, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 540.18, "standard_charge_percentage": 78.4000, "estimated_amount": 540, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 344.5, "standard_charge_percentage": 50.0000, "estimated_amount": 344, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 585.65, "standard_charge_percentage": 85.0000, "estimated_amount": 585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 585.65, "standard_charge_percentage": 85.0000, "estimated_amount": 585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 551.2, "standard_charge_percentage": 80.0000, "estimated_amount": 551, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 134.91, "standard_charge_percentage": 19.5800, "estimated_amount": 134, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 540.18, "standard_charge_percentage": 78.4000, "estimated_amount": 540, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 551.2, "standard_charge_percentage": 80.0000, "estimated_amount": 551, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "00811", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162.4,"minimum": 30.29,"maximum": 138.04,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 138.04, "standard_charge_percentage": 85.0000, "estimated_amount": 138, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 127.32, "standard_charge_percentage": 78.4000, "estimated_amount": 127, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 127.32, "standard_charge_percentage": 78.4000, "estimated_amount": 127, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 138.04, "standard_charge_percentage": 85.0000, "estimated_amount": 138, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 30.89, "standard_charge_percentage": 19.0200, "estimated_amount": 30, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 48.72, "standard_charge_percentage": 30.0000, "estimated_amount": 48, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 129.92, "standard_charge_percentage": 80.0000, "estimated_amount": 129, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 81.2, "standard_charge_percentage": 50.0000, "estimated_amount": 81, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 129.92, "standard_charge_percentage": 80.0000, "estimated_amount": 129, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 30.29, "standard_charge_percentage": 18.6500, "estimated_amount": 30, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "00840", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 407.75,"minimum": 76.05,"maximum": 346.59,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 76.05, "standard_charge_percentage": 18.6500, "estimated_amount": 76, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 346.59, "standard_charge_percentage": 85.0000, "estimated_amount": 346, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 346.59, "standard_charge_percentage": 85.0000, "estimated_amount": 346, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 79.84, "standard_charge_percentage": 19.5800, "estimated_amount": 79, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 319.68, "standard_charge_percentage": 78.4000, "estimated_amount": 319, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 319.68, "standard_charge_percentage": 78.4000, "estimated_amount": 319, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 203.88, "standard_charge_percentage": 50.0000, "estimated_amount": 203, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 326.2, "standard_charge_percentage": 80.0000, "estimated_amount": 326, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 77.57, "standard_charge_percentage": 19.0200, "estimated_amount": 77, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 326.2, "standard_charge_percentage": 80.0000, "estimated_amount": 326, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 122.33, "standard_charge_percentage": 30.0000, "estimated_amount": 122, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Anesth Vag Delivery, Epidural", "code_information": [ { "code": "01967", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 519,"minimum": 96.79,"maximum": 441.15,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 441.15, "standard_charge_percentage": 85.0000, "estimated_amount": 441, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 415.2, "standard_charge_percentage": 80.0000, "estimated_amount": 415, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 406.9, "standard_charge_percentage": 78.4000, "estimated_amount": 406, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 259.5, "standard_charge_percentage": 50.0000, "estimated_amount": 259, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 98.73, "standard_charge_percentage": 19.0200, "estimated_amount": 98, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 155.7, "standard_charge_percentage": 30.0000, "estimated_amount": 155, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 101.62, "standard_charge_percentage": 19.5800, "estimated_amount": 101, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 406.9, "standard_charge_percentage": 78.4000, "estimated_amount": 406, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 96.79, "standard_charge_percentage": 18.6500, "estimated_amount": 96, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 441.15, "standard_charge_percentage": 85.0000, "estimated_amount": 441, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 415.2, "standard_charge_percentage": 80.0000, "estimated_amount": 415, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Nfct Ds Bct/Vir Respir Dna/Rna 22 Trgt Sarscov2", "code_information": [ { "code": "0202U", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2083.9, "discounted_cash": 541,"minimum": 250.07,"maximum": 1771.32,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 250.07, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1771.32, "standard_charge_percentage": 85.0000, "estimated_amount": 1771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1771.32, "standard_charge_percentage": 85.0000, "estimated_amount": 1771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1667.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1667, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 416.78, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 416.78, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 562.65, "estimated_amount": 562, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.78, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.78, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 500.14, "estimated_amount": 500, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 833.56, "estimated_amount": 833, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 416.78, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 604.33, "estimated_amount": 604, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.78, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 883.57, "estimated_amount": 883, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 416.78, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 250.07, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 388.65, "standard_charge_percentage": 18.6500, "estimated_amount": 388, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1633.78, "standard_charge_percentage": 78.4000, "estimated_amount": 1633, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.78, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 333.42, "estimated_amount": 333, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1471.23, "estimated_amount": 1471, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1471.23, "estimated_amount": 1471, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1471.23, "estimated_amount": 1471, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 583.49, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 416.78, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 416.78, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1041.95, "standard_charge_percentage": 50.0000, "estimated_amount": 1041, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 416.78, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 833.56, "estimated_amount": 833, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1667.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1667, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 625.17, "standard_charge_percentage": 30.0000, "estimated_amount": 625, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1633.78, "standard_charge_percentage": 78.4000, "estimated_amount": 1633, "methodology": "percent of total billed charges" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 437.62, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 883.57, "estimated_amount": 883, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "0232T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27491, "discounted_cash": 610,"minimum": 375.94,"maximum": 21992.8,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 469.93, "estimated_amount": 469, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 375.94, "estimated_amount": 375, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 751.89, "estimated_amount": 751, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 657.9, "estimated_amount": 657, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 939.86, "estimated_amount": 939, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 996.25, "estimated_amount": 996, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 21992.8, "standard_charge_percentage": 80.0000, "estimated_amount": 21992, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5382.74, "standard_charge_percentage": 19.5800, "estimated_amount": 5382, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 13745.5, "standard_charge_percentage": 50.0000, "estimated_amount": 13745, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 634.41, "estimated_amount": 634, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 469.93, "estimated_amount": 469, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 469.93, "estimated_amount": 469, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 808.75, "estimated_amount": 808, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 469.93, "estimated_amount": 469, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 690.56, "estimated_amount": 690, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 469.93, "estimated_amount": 469, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 996.25, "estimated_amount": 996, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5229.61, "standard_charge_percentage": 19.0200, "estimated_amount": 5229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8247.3, "standard_charge_percentage": 30.0000, "estimated_amount": 8247, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 469.93, "estimated_amount": 469, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 469.93, "estimated_amount": 469, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 808.75, "estimated_amount": 808, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 939.86, "estimated_amount": 939, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 493.43, "estimated_amount": 493, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 469.93, "estimated_amount": 469, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5127.07, "standard_charge_percentage": 18.6500, "estimated_amount": 5127, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 21992.8, "standard_charge_percentage": 80.0000, "estimated_amount": 21992, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 469.93, "estimated_amount": 469, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 808.75, "estimated_amount": 808, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 469.93, "estimated_amount": 469, "methodology": "fee schedule" }]}]} , { "description": "Hc Translum Peripheral Atherectomy Abdom Aorta", "code_information": [ { "code": "0236T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48345.2, "discounted_cash": 17361,"minimum": 2472,"maximum": 38676.2,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 7566, "estimated_amount": 7566, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 9196.71, "standard_charge_percentage": 19.0200, "estimated_amount": 9196, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 9465.99, "standard_charge_percentage": 19.5800, "estimated_amount": 9465, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13355.3, "estimated_amount": 13355, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 18697.5, "estimated_amount": 18697, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 26710.7, "estimated_amount": 26710, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 28313.3, "estimated_amount": 28313, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 2472, "estimated_amount": 2472, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 18029.7, "estimated_amount": 18029, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 22984.5, "estimated_amount": 22984, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 22984.5, "estimated_amount": 22984, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 26710.7, "estimated_amount": 26710, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 13355.3, "estimated_amount": 13355, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 14023.1, "estimated_amount": 14023, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 38676.2, "standard_charge_percentage": 80.0000, "estimated_amount": 38676, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 13355.3, "estimated_amount": 13355, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 13355.3, "estimated_amount": 13355, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13355.3, "estimated_amount": 13355, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 10684.3, "estimated_amount": 10684, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 21368.5, "estimated_amount": 21368, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 13355.3, "estimated_amount": 13355, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 2753, "estimated_amount": 2753, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 9016.38, "standard_charge_percentage": 18.6500, "estimated_amount": 9016, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 38676.2, "standard_charge_percentage": 80.0000, "estimated_amount": 38676, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 14503.6, "standard_charge_percentage": 30.0000, "estimated_amount": 14503, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 13355.3, "estimated_amount": 13355, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 13355.3, "estimated_amount": 13355, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 22984.5, "estimated_amount": 22984, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 13355.3, "estimated_amount": 13355, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 19625.7, "estimated_amount": 19625, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 13355.3, "estimated_amount": 13355, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 28313.3, "estimated_amount": 28313, "methodology": "fee schedule" }]}]} , { "description": "Hc Translum Peripheral Atherectomy Iliac Artery Ea", "code_information": [ { "code": "0238T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18000, "discounted_cash": 27490,"minimum": 2472,"maximum": 18000,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 18000, "estimated_amount": 18000, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 18000, "estimated_amount": 18000, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 18000, "estimated_amount": 18000, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 18000, "estimated_amount": 18000, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3424.14, "standard_charge_percentage": 19.0200, "estimated_amount": 3424, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3524.4, "standard_charge_percentage": 19.5800, "estimated_amount": 3524, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 18000, "estimated_amount": 18000, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 18000, "estimated_amount": 18000, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 18000, "estimated_amount": 18000, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 18000, "estimated_amount": 18000, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 18000, "estimated_amount": 18000, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 18000, "estimated_amount": 18000, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 18000, "estimated_amount": 18000, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 2753, "estimated_amount": 2753, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14400, "standard_charge_percentage": 80.0000, "estimated_amount": 14400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 18000, "estimated_amount": 18000, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 16917.5, "estimated_amount": 16917, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 18000, "estimated_amount": 18000, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 18000, "estimated_amount": 18000, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 18000, "estimated_amount": 18000, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 18000, "estimated_amount": 18000, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 18000, "estimated_amount": 18000, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 7566, "estimated_amount": 7566, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9000, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 2472, "estimated_amount": 2472, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3357, "standard_charge_percentage": 18.6500, "estimated_amount": 3357, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14400, "standard_charge_percentage": 80.0000, "estimated_amount": 14400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5400, "standard_charge_percentage": 30.0000, "estimated_amount": 5400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 18000, "estimated_amount": 18000, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 18000, "estimated_amount": 18000, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 18000, "estimated_amount": 18000, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 18000, "estimated_amount": 18000, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 18000, "estimated_amount": 18000, "methodology": "fee schedule" }]}]} , { "description": "Hc Nfct Ds Rna 4 Targets Upper Respiratory Specimen", "code_information": [ { "code": "0241U", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 713.15, "discounted_cash": 185,"minimum": 114.1,"maximum": 606.18,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 606.18, "standard_charge_percentage": 85.0000, "estimated_amount": 606, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 213.94, "standard_charge_percentage": 30.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 559.11, "standard_charge_percentage": 78.4000, "estimated_amount": 559, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 559.11, "standard_charge_percentage": 78.4000, "estimated_amount": 559, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 142.63, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 192.55, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 114.1, "estimated_amount": 114, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 245.47, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 228.21, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 285.26, "estimated_amount": 285, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 285.26, "estimated_amount": 285, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 142.63, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 142.63, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 133, "standard_charge_percentage": 18.6500, "estimated_amount": 133, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 356.57, "standard_charge_percentage": 50.0000, "estimated_amount": 356, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 142.63, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 245.47, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 199.68, "estimated_amount": 199, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 209.59, "estimated_amount": 209, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 142.63, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 570.52, "standard_charge_percentage": 80.0000, "estimated_amount": 570, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 142.63, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 142.63, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 142.63, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 142.63, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 245.47, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 142.63, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 142.63, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 606.18, "standard_charge_percentage": 85.0000, "estimated_amount": 606, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 570.52, "standard_charge_percentage": 80.0000, "estimated_amount": 570, "methodology": "percent of total billed charges" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 149.76, "estimated_amount": 149, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 302.38, "estimated_amount": 302, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 302.38, "estimated_amount": 302, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "0274T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13674, "discounted_cash": 10936,"minimum": 1715,"maximum": 13674,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2550.2, "standard_charge_percentage": 18.6500, "estimated_amount": 2550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2677.37, "standard_charge_percentage": 19.5800, "estimated_amount": 2677, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 13674, "estimated_amount": 13674, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 13674, "estimated_amount": 13674, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10939.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10939.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 13674, "estimated_amount": 13674, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 13674, "estimated_amount": 13674, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4102.2, "standard_charge_percentage": 30.0000, "estimated_amount": 4102, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 13674, "estimated_amount": 13674, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 13674, "estimated_amount": 13674, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 13674, "estimated_amount": 13674, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2601.21, "standard_charge_percentage": 19.0200, "estimated_amount": 2601, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 6837, "standard_charge_percentage": 50.0000, "estimated_amount": 6837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "0275T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 10936,"minimum": 1715,"maximum": 15390,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000, "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 15390, "estimated_amount": 15390, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 15390, "estimated_amount": 15390, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 15390, "estimated_amount": 15390, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 15390, "estimated_amount": 15390, "methodology": "fee schedule" }]}]} , { "description": "FNA BX US GUIDANCE 1ST LESION", "code_information": [ { "code": "10005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3050.05, "discounted_cash": 1077,"minimum": 568.83,"maximum": 3050.05,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 2391.24, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2391, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 568.83, "standard_charge_percentage": 18.6500, "estimated_amount": 568, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 597.2, "standard_charge_percentage": 19.5800, "estimated_amount": 597, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2440.04, "standard_charge_percentage": 80.0000, "estimated_amount": 2440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 915.01, "standard_charge_percentage": 30.0000, "estimated_amount": 915, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 2391.24, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2391, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2440.04, "standard_charge_percentage": 80.0000, "estimated_amount": 2440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3050.05, "estimated_amount": 3050, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1525.03, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1525, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 580.21, "standard_charge_percentage": 19.0200, "estimated_amount": 580, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" }]}]} , { "description": "FNA BX US GDN EA ADDL LESION", "code_information": [ { "code": "10006", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1598.55,"minimum": 298.13,"maximum": 1598.55,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1598.55, "estimated_amount": 1598, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1598.55, "estimated_amount": 1598, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1278.84, "standard_charge_percentage": 80.0000, "estimated_amount": 1278, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 799.27, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 799, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1253.26, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1253, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1253.26, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1253, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 313, "standard_charge_percentage": 19.5800, "estimated_amount": 313, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 298.13, "standard_charge_percentage": 18.6500, "estimated_amount": 298, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 479.56, "standard_charge_percentage": 30.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1598.55, "estimated_amount": 1598, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1598.55, "estimated_amount": 1598, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 304.09, "standard_charge_percentage": 19.0200, "estimated_amount": 304, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1278.84, "standard_charge_percentage": 80.0000, "estimated_amount": 1278, "methodology": "percent of total billed charges" }]}]} , { "description": "FNA BX CT GUIDANCE 1ST LESION", "code_information": [ { "code": "10009", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3050.05, "discounted_cash": 1077,"minimum": 568.83,"maximum": 3050.05,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1525.03, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1525, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 2391.24, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2391, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 580.21, "standard_charge_percentage": 19.0200, "estimated_amount": 580, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2440.04, "standard_charge_percentage": 80.0000, "estimated_amount": 2440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3050.05, "estimated_amount": 3050, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 2391.24, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2391, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 568.83, "standard_charge_percentage": 18.6500, "estimated_amount": 568, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2440.04, "standard_charge_percentage": 80.0000, "estimated_amount": 2440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 915.01, "standard_charge_percentage": 30.0000, "estimated_amount": 915, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 597.2, "standard_charge_percentage": 19.5800, "estimated_amount": 597, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" }]}]} , { "description": "ENDOVENOUS RF VEIN ADD-ON", "code_information": [ { "code": "10021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 868, "discounted_cash": 611,"minimum": 161.88,"maximum": 868,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 868, "estimated_amount": 868, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 868, "estimated_amount": 868, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 680.51, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 680, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 161.88, "standard_charge_percentage": 18.6500, "estimated_amount": 161, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 165.12, "standard_charge_percentage": 19.0200, "estimated_amount": 165, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 868, "estimated_amount": 868, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 868, "estimated_amount": 868, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 169.95, "standard_charge_percentage": 19.5800, "estimated_amount": 169, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 868, "estimated_amount": 868, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 680.51, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 680, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 868, "estimated_amount": 868, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 868, "estimated_amount": 868, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 434, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 434, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 260.4, "standard_charge_percentage": 30.0000, "estimated_amount": 260, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 868, "estimated_amount": 868, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" }]}]} , { "description": "INS ENDOVAS VENA CAVA FILTR", "code_information": [ { "code": "10030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2888.35, "discounted_cash": 1077,"minimum": 538.68,"maximum": 2888.35,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 549.45, "standard_charge_percentage": 19.0200, "estimated_amount": 549, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 866.5, "standard_charge_percentage": 30.0000, "estimated_amount": 866, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 2264.47, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2264, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2310.68, "standard_charge_percentage": 80.0000, "estimated_amount": 2310, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 2264.47, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2264, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 565.54, "standard_charge_percentage": 19.5800, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2310.68, "standard_charge_percentage": 80.0000, "estimated_amount": 2310, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2888.35, "estimated_amount": 2888, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1444.17, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1444, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 538.68, "standard_charge_percentage": 18.6500, "estimated_amount": 538, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" }]}]} , { "description": "Hc Acne Surgery Of Skin Abscess", "code_information": [ { "code": "10040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.4, "discounted_cash": 304,"minimum": 34.58,"maximum": 185.4,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 34.58, "standard_charge_percentage": 18.6500, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 185.4, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 185.4, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 185.4, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 185.4, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 185.4, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 185.4, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 185.4, "estimated_amount": 185, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 185.4, "estimated_amount": 185, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 145.35, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 145, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 35.27, "standard_charge_percentage": 19.0200, "estimated_amount": 35, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 185.4, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 185.4, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 185.4, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 185.4, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 185.4, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 145.35, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 145, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 185.4, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 185.4, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 185.4, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 185.4, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 185.4, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 185.4, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 185.4, "estimated_amount": 185, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 92.7, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 92, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 185.4, "estimated_amount": 185, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 148.32, "standard_charge_percentage": 80.0000, "estimated_amount": 148, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 55.62, "standard_charge_percentage": 30.0000, "estimated_amount": 55, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 36.3, "standard_charge_percentage": 19.5800, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 148.32, "standard_charge_percentage": 80.0000, "estimated_amount": 148, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 185.4, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 185.4, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 185.4, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 185.4, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 185.4, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 185.4, "estimated_amount": 185, "methodology": "fee schedule" }]}]} , { "description": "Hc Incision & Drain Skin Abscess Simple", "code_information": [ { "code": "10060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 821.86, "discounted_cash": 304,"minimum": 153.28,"maximum": 13848,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 644.34, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 160.92, "standard_charge_percentage": 19.5800, "estimated_amount": 160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 374.4, "estimated_amount": 374, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3292.88, "standard_charge_percentage": 19.0200, "estimated_amount": 3292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 187.2, "estimated_amount": 187, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 343.86, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 156.34, "standard_charge_percentage": 19.0200, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 657.49, "standard_charge_percentage": 80.0000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 657.49, "standard_charge_percentage": 80.0000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 315.9, "estimated_amount": 315, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 187.2, "estimated_amount": 187, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 245.7, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 410.93, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 410, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 644.34, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 343.86, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3389.3, "standard_charge_percentage": 19.5800, "estimated_amount": 3389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 374.4, "estimated_amount": 374, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 153.28, "standard_charge_percentage": 18.6500, "estimated_amount": 153, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 246.56, "standard_charge_percentage": 30.0000, "estimated_amount": 246, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3228.32, "standard_charge_percentage": 18.6500, "estimated_amount": 3228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5193, "standard_charge_percentage": 30.0000, "estimated_amount": 5193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 315.9, "estimated_amount": 315, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 245.7, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8655, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" }]}]} , { "description": "Hc Incision & Drain Skin Abscess Complic", "code_information": [ { "code": "10061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1636.94, "discounted_cash": 611,"minimum": 305.29,"maximum": 1636.94,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 311.4, "standard_charge_percentage": 19.0200, "estimated_amount": 311, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 491.08, "standard_charge_percentage": 30.0000, "estimated_amount": 491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1309.55, "standard_charge_percentage": 80.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 818.47, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 818, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 305.29, "standard_charge_percentage": 18.6500, "estimated_amount": 305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 320.51, "standard_charge_percentage": 19.5800, "estimated_amount": 320, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1283.36, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1283.36, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1309.55, "standard_charge_percentage": 80.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" }]}]} , { "description": "Hc Incision & Drain Pilonidal Cyst Simpl", "code_information": [ { "code": "10080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2888.35, "discounted_cash": 1077,"minimum": 538.68,"maximum": 13848,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 549.45, "standard_charge_percentage": 19.0200, "estimated_amount": 549, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 866.5, "standard_charge_percentage": 30.0000, "estimated_amount": 866, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 2264.47, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2264, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2310.68, "standard_charge_percentage": 80.0000, "estimated_amount": 2310, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2888.35, "estimated_amount": 2888, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1444.17, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1444, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 538.68, "standard_charge_percentage": 18.6500, "estimated_amount": 538, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8655, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3389.3, "standard_charge_percentage": 19.5800, "estimated_amount": 3389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 2264.47, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2264, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 565.54, "standard_charge_percentage": 19.5800, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2310.68, "standard_charge_percentage": 80.0000, "estimated_amount": 2310, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3228.32, "standard_charge_percentage": 18.6500, "estimated_amount": 3228, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3292.88, "standard_charge_percentage": 19.0200, "estimated_amount": 3292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5193, "standard_charge_percentage": 30.0000, "estimated_amount": 5193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" }]}]} , { "description": "RMVL TUNNLED CV CATH W/PORT", "code_information": [ { "code": "10081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2159.45, "discounted_cash": 1077,"minimum": 402.74,"maximum": 2159.45,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2159.45, "estimated_amount": 2159, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1693.01, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1693, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 402.74, "standard_charge_percentage": 18.6500, "estimated_amount": 402, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2159.45, "estimated_amount": 2159, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1693.01, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1693, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 410.79, "standard_charge_percentage": 19.0200, "estimated_amount": 410, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 422.82, "standard_charge_percentage": 19.5800, "estimated_amount": 422, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1079.72, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1079, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 647.83, "standard_charge_percentage": 30.0000, "estimated_amount": 647, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1727.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1727, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1727.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1727, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" }]}]} , { "description": "EXC SHOULDER LES SUBQ 3CM/>", "code_information": [ { "code": "10120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1636.94, "discounted_cash": 611,"minimum": 305.29,"maximum": 12312,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 305.29, "standard_charge_percentage": 18.6500, "estimated_amount": 305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 320.51, "standard_charge_percentage": 19.5800, "estimated_amount": 320, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 311.4, "standard_charge_percentage": 19.0200, "estimated_amount": 311, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 491.08, "standard_charge_percentage": 30.0000, "estimated_amount": 491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1309.55, "standard_charge_percentage": 80.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1283.36, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1309.55, "standard_charge_percentage": 80.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 818.47, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 818, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1283.36, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" }]}]} , { "description": "Hc Remove Foreign Body Complex", "code_information": [ { "code": "10121", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4379.25, "discounted_cash": 2480,"minimum": 816.73,"maximum": 4045.15,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3433.33, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3433, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3503.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3503, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1313.78, "standard_charge_percentage": 30.0000, "estimated_amount": 1313, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2189.63, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2189, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3433.33, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3433, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 833.06, "standard_charge_percentage": 19.0200, "estimated_amount": 833, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 857.46, "standard_charge_percentage": 19.5800, "estimated_amount": 857, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3503.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3503, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 816.73, "standard_charge_percentage": 18.6500, "estimated_amount": 816, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "I&R FOREIGN BDY SUBQ TISS SMPL", "code_information": [ { "code": "10140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6655.86, "discounted_cash": 2480,"minimum": 1241.32,"maximum": 13464,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1996.76, "standard_charge_percentage": 30.0000, "estimated_amount": 1996, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8415, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8415, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3138.8, "standard_charge_percentage": 18.6500, "estimated_amount": 3138, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5049, "standard_charge_percentage": 30.0000, "estimated_amount": 5049, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13464, "standard_charge_percentage": 80.0000, "estimated_amount": 13464, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1241.32, "standard_charge_percentage": 18.6500, "estimated_amount": 1241, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1266.14, "standard_charge_percentage": 19.0200, "estimated_amount": 1266, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5324.69, "standard_charge_percentage": 80.0000, "estimated_amount": 5324, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3327.93, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3327, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5324.69, "standard_charge_percentage": 80.0000, "estimated_amount": 5324, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3295.31, "standard_charge_percentage": 19.5800, "estimated_amount": 3295, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1303.22, "standard_charge_percentage": 19.5800, "estimated_amount": 1303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3201.57, "standard_charge_percentage": 19.0200, "estimated_amount": 3201, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13464, "standard_charge_percentage": 80.0000, "estimated_amount": 13464, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" }]}]} , { "description": "EXC BEN LES SC/NK/H/F0.6-1.0CM", "code_information": [ { "code": "10160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1636.94, "discounted_cash": 611,"minimum": 305.29,"maximum": 1636.94,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1309.55, "standard_charge_percentage": 80.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 818.47, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 818, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 320.51, "standard_charge_percentage": 19.5800, "estimated_amount": 320, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1283.36, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 305.29, "standard_charge_percentage": 18.6500, "estimated_amount": 305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 491.08, "standard_charge_percentage": 30.0000, "estimated_amount": 491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1283.36, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1283, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 311.4, "standard_charge_percentage": 19.0200, "estimated_amount": 311, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1309.55, "standard_charge_percentage": 80.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" }]}]} , { "description": "Hc Complex Drainage, Wound", "code_information": [ { "code": "10180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11665.2, "discounted_cash": 4381,"minimum": 1715,"maximum": 9332.16,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9332.16, "standard_charge_percentage": 80.0000, "estimated_amount": 9332, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5832.6, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5832, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2219.07, "standard_charge_percentage": 19.0200, "estimated_amount": 2219, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2284.05, "standard_charge_percentage": 19.5800, "estimated_amount": 2284, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9332.16, "standard_charge_percentage": 80.0000, "estimated_amount": 9332, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3499.56, "standard_charge_percentage": 30.0000, "estimated_amount": 3499, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2175.56, "standard_charge_percentage": 18.6500, "estimated_amount": 2175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" }]}]} , { "description": "PUNCH BIOPSY SKIN SNGL LESION", "code_information": [ { "code": "11000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3051.23, "discounted_cash": 937,"minimum": 569.05,"maximum": 3051.23,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1525.62, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1525, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 580.44, "standard_charge_percentage": 19.0200, "estimated_amount": 580, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 915.37, "standard_charge_percentage": 30.0000, "estimated_amount": 915, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 597.43, "standard_charge_percentage": 19.5800, "estimated_amount": 597, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1009.23, "estimated_amount": 1009, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2440.98, "standard_charge_percentage": 80.0000, "estimated_amount": 2440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 973.19, "estimated_amount": 973, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1059.33, "estimated_amount": 1059, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3051.23, "estimated_amount": 3051, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 569.05, "standard_charge_percentage": 18.6500, "estimated_amount": 569, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2440.98, "standard_charge_percentage": 80.0000, "estimated_amount": 2440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 576.7, "estimated_amount": 576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1153.41, "estimated_amount": 1153, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 2392.16, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2392, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 2392.16, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2392, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 756.92, "estimated_amount": 756, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "11005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390,"minimum": 1715,"maximum": 12312,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 8999, "standard_charge_percentage": 70.6000,"standard_charge_algorithm": "Not To Exceed $8999", "estimated_amount": 8999, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 8999, "standard_charge_percentage": 70.6000,"standard_charge_algorithm": "Not To Exceed $8999", "estimated_amount": 8999, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4889, "estimated_amount": 4889, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 8999, "standard_charge_percentage": 70.6000,"standard_charge_algorithm": "Not To Exceed $8999", "estimated_amount": 8999, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3847.5, "standard_charge_percentage": 25.0000, "estimated_amount": 3847, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" }]}]} , { "description": "UNLISTED PROC NERVOUS SYSTEM", "code_information": [ { "code": "11010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2000, "discounted_cash": 1077,"minimum": 373,"maximum": 2000,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 380.46, "standard_charge_percentage": 19.0200, "estimated_amount": 380, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1000, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1600, "standard_charge_percentage": 80.0000, "estimated_amount": 1600, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 391.6, "standard_charge_percentage": 19.5800, "estimated_amount": 391, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2000, "estimated_amount": 2000, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1568, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1568, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1568, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1568, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 373, "standard_charge_percentage": 18.6500, "estimated_amount": 373, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 600, "standard_charge_percentage": 30.0000, "estimated_amount": 600, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2000, "estimated_amount": 2000, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1600, "standard_charge_percentage": 80.0000, "estimated_amount": 1600, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" }]}]} , { "description": "Hc Dbrdmt W/Rmvl Fm Fx&/Dislc Skn Subq T/M/F Musc", "code_information": [ { "code": "11011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1951.33, "discounted_cash": 1077,"minimum": 363.92,"maximum": 1951.33,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1529.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1529.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 975.66, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 975, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 363.92, "standard_charge_percentage": 18.6500, "estimated_amount": 363, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 382.07, "standard_charge_percentage": 19.5800, "estimated_amount": 382, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1951.33, "estimated_amount": 1951, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1951.33, "estimated_amount": 1951, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 371.2, "standard_charge_percentage": 19.0200, "estimated_amount": 371, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1561.06, "standard_charge_percentage": 80.0000, "estimated_amount": 1561, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 585.4, "standard_charge_percentage": 30.0000, "estimated_amount": 585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1561.06, "standard_charge_percentage": 80.0000, "estimated_amount": 1561, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1951.33, "estimated_amount": 1951, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" }]}]} , { "description": "Deb skin bone at fx site", "code_information": [ { "code": "11012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10780, "discounted_cash": 4381,"minimum": 1715,"maximum": 8624.01,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3234, "standard_charge_percentage": 30.0000, "estimated_amount": 3234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2110.73, "standard_charge_percentage": 19.5800, "estimated_amount": 2110, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5390.01, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5390, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2010.47, "standard_charge_percentage": 18.6500, "estimated_amount": 2010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8624.01, "standard_charge_percentage": 80.0000, "estimated_amount": 8624, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8624.01, "standard_charge_percentage": 80.0000, "estimated_amount": 8624, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2050.68, "standard_charge_percentage": 19.0200, "estimated_amount": 2050, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" }]}]} , { "description": "RMVL TUNNELED CV CATH WO PORT", "code_information": [ { "code": "11042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1945, "discounted_cash": 611,"minimum": 362.74,"maximum": 12312,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1945, "estimated_amount": 1945, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1945, "estimated_amount": 1945, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1524.88, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1524, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1556, "standard_charge_percentage": 80.0000, "estimated_amount": 1556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1524.88, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1524, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 370, "standard_charge_percentage": 19.0200, "estimated_amount": 370, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1556, "standard_charge_percentage": 80.0000, "estimated_amount": 1556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1945, "estimated_amount": 1945, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 972.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 972, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 362.74, "standard_charge_percentage": 18.6500, "estimated_amount": 362, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 583.5, "standard_charge_percentage": 30.0000, "estimated_amount": 583, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 380.83, "standard_charge_percentage": 19.5800, "estimated_amount": 380, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" }]}]} , { "description": "I&D ABSCESS DEEP LEG/ANKLE", "code_information": [ { "code": "11043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2578.33, "discounted_cash": 937,"minimum": 480.86,"maximum": 13848,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1289.16, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1289, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 773.5, "standard_charge_percentage": 30.0000, "estimated_amount": 773, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 973.19, "estimated_amount": 973, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 576.7, "estimated_amount": 576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1059.33, "estimated_amount": 1059, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3292.88, "standard_charge_percentage": 19.0200, "estimated_amount": 3292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 576.7, "estimated_amount": 576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1009.23, "estimated_amount": 1009, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1059.33, "estimated_amount": 1059, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2578.33, "estimated_amount": 2578, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 480.86, "standard_charge_percentage": 18.6500, "estimated_amount": 480, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 490.48, "standard_charge_percentage": 19.0200, "estimated_amount": 490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2062.66, "standard_charge_percentage": 80.0000, "estimated_amount": 2062, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1009.23, "estimated_amount": 1009, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 2021.41, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2021, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 2021.41, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2021, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 504.84, "standard_charge_percentage": 19.5800, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1153.41, "estimated_amount": 1153, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3228.32, "standard_charge_percentage": 18.6500, "estimated_amount": 3228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1153.41, "estimated_amount": 1153, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2062.66, "standard_charge_percentage": 80.0000, "estimated_amount": 2062, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 756.92, "estimated_amount": 756, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5193, "standard_charge_percentage": 30.0000, "estimated_amount": 5193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3389.3, "standard_charge_percentage": 19.5800, "estimated_amount": 3389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8655, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 973.19, "estimated_amount": 973, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 756.92, "estimated_amount": 756, "methodology": "fee schedule" }]}]} , { "description": "INS PICC LINE WO IMG GUID 5YR+", "code_information": [ { "code": "11044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6655.86, "discounted_cash": 2480,"minimum": 1241.32,"maximum": 13080,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1241.32, "standard_charge_percentage": 18.6500, "estimated_amount": 1241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8175, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5324.69, "standard_charge_percentage": 80.0000, "estimated_amount": 5324, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1996.76, "standard_charge_percentage": 30.0000, "estimated_amount": 1996, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1303.22, "standard_charge_percentage": 19.5800, "estimated_amount": 1303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3327.93, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3327, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1266.14, "standard_charge_percentage": 19.0200, "estimated_amount": 1266, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5324.69, "standard_charge_percentage": 80.0000, "estimated_amount": 5324, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3110.26, "standard_charge_percentage": 19.0200, "estimated_amount": 3110, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13080, "standard_charge_percentage": 80.0000, "estimated_amount": 13080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13080, "standard_charge_percentage": 80.0000, "estimated_amount": 13080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3049.28, "standard_charge_percentage": 18.6500, "estimated_amount": 3049, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3201.33, "standard_charge_percentage": 19.5800, "estimated_amount": 3201, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4905, "standard_charge_percentage": 30.0000, "estimated_amount": 4905, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "DECLOT PORT W/ THROMB AGNT", "code_information": [ { "code": "11045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1206,"minimum": 224.92,"maximum": 1206,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1206, "estimated_amount": 1206, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1206, "estimated_amount": 1206, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 945.5, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 945, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1206, "estimated_amount": 1206, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1206, "estimated_amount": 1206, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 224.92, "standard_charge_percentage": 18.6500, "estimated_amount": 224, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 229.42, "standard_charge_percentage": 19.0200, "estimated_amount": 229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 236.13, "standard_charge_percentage": 19.5800, "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 964.8, "standard_charge_percentage": 80.0000, "estimated_amount": 964, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 603, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 945.5, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 945, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 964.8, "standard_charge_percentage": 80.0000, "estimated_amount": 964, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 361.8, "standard_charge_percentage": 30.0000, "estimated_amount": 361, "methodology": "percent of total billed charges" }]}]} , { "description": "RPLC TUNNELED CV CATH W/PORT", "code_information": [ { "code": "11046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1168.5,"minimum": 217.93,"maximum": 1168.5,"payers_information":[{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 934.8, "standard_charge_percentage": 80.0000, "estimated_amount": 934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 916.1, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 217.93, "standard_charge_percentage": 18.6500, "estimated_amount": 217, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1168.5, "estimated_amount": 1168, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1168.5, "estimated_amount": 1168, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 934.8, "standard_charge_percentage": 80.0000, "estimated_amount": 934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 228.79, "standard_charge_percentage": 19.5800, "estimated_amount": 228, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1168.5, "estimated_amount": 1168, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 584.25, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 584, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1168.5, "estimated_amount": 1168, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 916.1, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 916, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 222.28, "standard_charge_percentage": 19.0200, "estimated_amount": 222, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 350.55, "standard_charge_percentage": 30.0000, "estimated_amount": 350, "methodology": "percent of total billed charges" }]}]} , { "description": "COMPLETE RPL PICC WO PORT RS&I", "code_information": [ { "code": "11047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2970,"minimum": 553.9,"maximum": 2970,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 2328.48, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2328, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 553.9, "standard_charge_percentage": 18.6500, "estimated_amount": 553, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 564.98, "standard_charge_percentage": 19.0200, "estimated_amount": 564, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2970, "estimated_amount": 2970, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 891, "standard_charge_percentage": 30.0000, "estimated_amount": 891, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 581.53, "standard_charge_percentage": 19.5800, "estimated_amount": 581, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1485, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1485, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 2328.48, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2328, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2376, "standard_charge_percentage": 80.0000, "estimated_amount": 2376, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2376, "standard_charge_percentage": 80.0000, "estimated_amount": 2376, "methodology": "percent of total billed charges" }]}]} , { "description": "COMPLETE RPL PICC W/ PORT RS&I", "code_information": [ { "code": "11055", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 821.86, "discounted_cash": 304,"minimum": 153.28,"maximum": 821.86,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 410.93, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 410, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 644.34, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 160.92, "standard_charge_percentage": 19.5800, "estimated_amount": 160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 315.9, "estimated_amount": 315, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 153.28, "standard_charge_percentage": 18.6500, "estimated_amount": 153, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 374.4, "estimated_amount": 374, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 644.34, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 245.7, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 156.34, "standard_charge_percentage": 19.0200, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 657.49, "standard_charge_percentage": 80.0000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 246.56, "standard_charge_percentage": 30.0000, "estimated_amount": 246, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 657.49, "standard_charge_percentage": 80.0000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 187.2, "estimated_amount": 187, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 343.86, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" }]}]} , { "description": "PLC TUBE NASOGAST FLUOR GUIDE", "code_information": [ { "code": "11056", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 261, "discounted_cash": 304,"minimum": 48.68,"maximum": 261,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 261, "estimated_amount": 261, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 49.65, "standard_charge_percentage": 19.0200, "estimated_amount": 49, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 208.8, "standard_charge_percentage": 80.0000, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 78.3, "standard_charge_percentage": 30.0000, "estimated_amount": 78, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 261, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 261, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 261, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 261, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 261, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 261, "estimated_amount": 261, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 261, "estimated_amount": 261, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 261, "estimated_amount": 261, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 204.62, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 204, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 51.1, "standard_charge_percentage": 19.5800, "estimated_amount": 51, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 208.8, "standard_charge_percentage": 80.0000, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 245.7, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 130.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 204.62, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 204, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 261, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 261, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 261, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 48.68, "standard_charge_percentage": 18.6500, "estimated_amount": 48, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 187.2, "estimated_amount": 187, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 261, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 261, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 261, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" }]}]} , { "description": "PUNCH BX SKIN EA ADDL LESION", "code_information": [ { "code": "11057", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 338.33, "discounted_cash": 304,"minimum": 63.1,"maximum": 338.33,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 338.33, "estimated_amount": 338, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 169.16, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 169, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 338.33, "estimated_amount": 338, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 338.33, "estimated_amount": 338, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 338.33, "estimated_amount": 338, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 338.33, "estimated_amount": 338, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 338.33, "estimated_amount": 338, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 265.25, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 265, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 64.36, "standard_charge_percentage": 19.0200, "estimated_amount": 64, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 101.5, "standard_charge_percentage": 30.0000, "estimated_amount": 101, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 270.66, "standard_charge_percentage": 80.0000, "estimated_amount": 270, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 338.33, "estimated_amount": 338, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 338.33, "estimated_amount": 338, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 265.25, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 265, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 270.66, "standard_charge_percentage": 80.0000, "estimated_amount": 270, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 66.25, "standard_charge_percentage": 19.5800, "estimated_amount": 66, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 338.33, "estimated_amount": 338, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 338.33, "estimated_amount": 338, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 63.1, "standard_charge_percentage": 18.6500, "estimated_amount": 63, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 315.9, "estimated_amount": 315, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 187.2, "estimated_amount": 187, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 338.33, "estimated_amount": 338, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 338.33, "estimated_amount": 338, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 245.7, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 338.33, "estimated_amount": 338, "methodology": "fee schedule" }]}]} , { "description": "Hc Tangential Biopsy Skin Single Lesion", "code_information": [ { "code": "11102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 992.77, "discounted_cash": 304,"minimum": 185.15,"maximum": 992.77,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 992.77, "estimated_amount": 992, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 185.15, "standard_charge_percentage": 18.6500, "estimated_amount": 185, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 194.38, "standard_charge_percentage": 19.5800, "estimated_amount": 194, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 343.86, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 992.77, "estimated_amount": 992, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 496.38, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 496, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 992.77, "estimated_amount": 992, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 778.33, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 778, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 992.77, "estimated_amount": 992, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 188.85, "standard_charge_percentage": 19.0200, "estimated_amount": 188, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 794.22, "standard_charge_percentage": 80.0000, "estimated_amount": 794, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 297.83, "standard_charge_percentage": 30.0000, "estimated_amount": 297, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 794.22, "standard_charge_percentage": 80.0000, "estimated_amount": 794, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 374.4, "estimated_amount": 374, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 778.33, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 778, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 315.9, "estimated_amount": 315, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 187.2, "estimated_amount": 187, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 245.7, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" }]}]} , { "description": "Hc Tangential Biopsy Skin Ea Sep/Additional Lesion", "code_information": [ { "code": "11103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 378.52,"minimum": 70.59,"maximum": 378.52,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 378.52, "estimated_amount": 378, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 302.82, "standard_charge_percentage": 80.0000, "estimated_amount": 302, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 378.52, "estimated_amount": 378, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 189.26, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 189, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 378.52, "estimated_amount": 378, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 296.76, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 296.76, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 302.82, "standard_charge_percentage": 80.0000, "estimated_amount": 302, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 74.11, "standard_charge_percentage": 19.5800, "estimated_amount": 74, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 378.52, "estimated_amount": 378, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 70.59, "standard_charge_percentage": 18.6500, "estimated_amount": 70, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 72.01, "standard_charge_percentage": 19.0200, "estimated_amount": 72, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 113.56, "standard_charge_percentage": 30.0000, "estimated_amount": 113, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Punch Biopsy Skin Single Lesion", "code_information": [ { "code": "11104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1636.94, "discounted_cash": 611,"minimum": 305.29,"maximum": 1636.94,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 818.47, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 818, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1283.36, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1283.36, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1283, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 311.4, "standard_charge_percentage": 19.0200, "estimated_amount": 311, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1309.55, "standard_charge_percentage": 80.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 305.29, "standard_charge_percentage": 18.6500, "estimated_amount": 305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1309.55, "standard_charge_percentage": 80.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 491.08, "standard_charge_percentage": 30.0000, "estimated_amount": 491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 320.51, "standard_charge_percentage": 19.5800, "estimated_amount": 320, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" }]}]} , { "description": "Hc Punch Biopsy Skin Ea Sep/Additional Lesion", "code_information": [ { "code": "11105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 582.3,"minimum": 108.6,"maximum": 582.3,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 582.3, "estimated_amount": 582, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 174.69, "standard_charge_percentage": 30.0000, "estimated_amount": 174, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 582.3, "estimated_amount": 582, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 582.3, "estimated_amount": 582, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 291.15, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 291, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 456.52, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 456, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 108.6, "standard_charge_percentage": 18.6500, "estimated_amount": 108, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 465.84, "standard_charge_percentage": 80.0000, "estimated_amount": 465, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 582.3, "estimated_amount": 582, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 456.52, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 456, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 465.84, "standard_charge_percentage": 80.0000, "estimated_amount": 465, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 110.77, "standard_charge_percentage": 19.0200, "estimated_amount": 110, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 114.01, "standard_charge_percentage": 19.5800, "estimated_amount": 114, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Incisional Biopsy Skin Single Lesion", "code_information": [ { "code": "11106", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1597.55, "discounted_cash": 937,"minimum": 297.94,"maximum": 1597.55,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1597.55, "estimated_amount": 1597, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1597.55, "estimated_amount": 1597, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1252.48, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1252, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 297.94, "standard_charge_percentage": 18.6500, "estimated_amount": 297, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1009.23, "estimated_amount": 1009, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1059.33, "estimated_amount": 1059, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 798.77, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 798, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1597.55, "estimated_amount": 1597, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1252.48, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1252, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 303.9, "standard_charge_percentage": 19.0200, "estimated_amount": 303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 312.8, "standard_charge_percentage": 19.5800, "estimated_amount": 312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1153.41, "estimated_amount": 1153, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 756.92, "estimated_amount": 756, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 479.26, "standard_charge_percentage": 30.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1278.04, "standard_charge_percentage": 80.0000, "estimated_amount": 1278, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1597.55, "estimated_amount": 1597, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1278.04, "standard_charge_percentage": 80.0000, "estimated_amount": 1278, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 973.19, "estimated_amount": 973, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 576.7, "estimated_amount": 576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" }]}]} , { "description": "EXC BEN LES TRNK ARM 1.1-2.0CM", "code_information": [ { "code": "11200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1138.74, "discounted_cash": 304,"minimum": 187.2,"maximum": 12312,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1138.74, "estimated_amount": 1138, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 216.62, "standard_charge_percentage": 19.0200, "estimated_amount": 216, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 910.99, "standard_charge_percentage": 80.0000, "estimated_amount": 910, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 374.4, "estimated_amount": 374, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1138.74, "estimated_amount": 1138, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 187.2, "estimated_amount": 187, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 343.86, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 569.37, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 569, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 892.77, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 892, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 212.38, "standard_charge_percentage": 18.6500, "estimated_amount": 212, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 910.99, "standard_charge_percentage": 80.0000, "estimated_amount": 910, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 374.4, "estimated_amount": 374, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 315.9, "estimated_amount": 315, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 245.7, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1138.74, "estimated_amount": 1138, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1138.74, "estimated_amount": 1138, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 892.77, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 892, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 341.62, "standard_charge_percentage": 30.0000, "estimated_amount": 341, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 222.97, "standard_charge_percentage": 19.5800, "estimated_amount": 222, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 315.9, "estimated_amount": 315, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 245.7, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 187.2, "estimated_amount": 187, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 343.86, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" }]}]} , { "description": "Hc Removal Sk Tgs Mlt Fibrq Tags Any Area Ea 10", "code_information": [ { "code": "11201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 375.67,"minimum": 70.06,"maximum": 375.67,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 187.84, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 294.53, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 294, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 71.46, "standard_charge_percentage": 19.0200, "estimated_amount": 71, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 375.67, "estimated_amount": 375, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 294.53, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 294, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 112.7, "standard_charge_percentage": 30.0000, "estimated_amount": 112, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 375.67, "estimated_amount": 375, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 375.67, "estimated_amount": 375, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 70.06, "standard_charge_percentage": 18.6500, "estimated_amount": 70, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 300.54, "standard_charge_percentage": 80.0000, "estimated_amount": 300, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 375.67, "estimated_amount": 375, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 73.56, "standard_charge_percentage": 19.5800, "estimated_amount": 73, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 300.54, "standard_charge_percentage": 80.0000, "estimated_amount": 300, "methodology": "percent of total billed charges" }]}]} , { "description": "Exc tr-ext b9+marg 0.5 cm<", "code_information": [ { "code": "11400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 1077,"minimum": 662.86,"maximum": 12312,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" }]}]} , { "description": "Exc tr-ext b9+marg 0.6-1 cm", "code_information": [ { "code": "11401", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 611,"minimum": 376.41,"maximum": 12312,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" }]}]} , { "description": "Hc Exc B9 Lesion Mrgn Xcp Sk Tg T/A/L 1.1-2.0 Cm", "code_information": [ { "code": "11402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2236.79, "discounted_cash": 1077,"minimum": 417.16,"maximum": 12312,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 671.04, "standard_charge_percentage": 30.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 437.96, "standard_charge_percentage": 19.5800, "estimated_amount": 437, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2236.79, "estimated_amount": 2236, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2236.79, "estimated_amount": 2236, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1753.64, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1753, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1753.64, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1753, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1789.43, "standard_charge_percentage": 80.0000, "estimated_amount": 1789, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1118.39, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1118, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 417.16, "standard_charge_percentage": 18.6500, "estimated_amount": 417, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 425.5, "standard_charge_percentage": 19.0200, "estimated_amount": 425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1789.43, "standard_charge_percentage": 80.0000, "estimated_amount": 1789, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" }]}]} , { "description": "Hc Exc B9 Lesion Mrgn Xcp Sk Tg T/A/L 2.1-3.0 Cm", "code_information": [ { "code": "11403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 1077,"minimum": 662.86,"maximum": 12312,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 895.96, "standard_charge_percentage": 19.0200, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 922.2, "standard_charge_percentage": 19.5800, "estimated_amount": 922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3692.56, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3692, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3692.56, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3692, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 878.4, "standard_charge_percentage": 18.6500, "estimated_amount": 878, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" }]}]} , { "description": "Exc tr-ext b9+marg 3.1-4 cm", "code_information": [ { "code": "11404", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16159.5, "discounted_cash": 2480,"minimum": 1526.47,"maximum": 12927.6,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8079.75, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8079, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3164.03, "standard_charge_percentage": 19.5800, "estimated_amount": 3164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3013.75, "standard_charge_percentage": 18.6500, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3074.02, "standard_charge_percentage": 19.0200, "estimated_amount": 3074, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12927.6, "standard_charge_percentage": 80.0000, "estimated_amount": 12927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4847.85, "standard_charge_percentage": 30.0000, "estimated_amount": 4847, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12927.6, "standard_charge_percentage": 80.0000, "estimated_amount": 12927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" }]}]} , { "description": "Hc Exc B9 Lesion Mrgn Xcp Sk Tg T/A/L >4.0 Cm", "code_information": [ { "code": "11406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4602.72, "discounted_cash": 2480,"minimum": 858.41,"maximum": 12312,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 858.41, "standard_charge_percentage": 18.6500, "estimated_amount": 858, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3682.18, "standard_charge_percentage": 80.0000, "estimated_amount": 3682, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3682.18, "standard_charge_percentage": 80.0000, "estimated_amount": 3682, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1380.82, "standard_charge_percentage": 30.0000, "estimated_amount": 1380, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 901.21, "standard_charge_percentage": 19.5800, "estimated_amount": 901, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 875.58, "standard_charge_percentage": 19.0200, "estimated_amount": 875, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2301.36, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2301, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3608.53, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3608, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3608.53, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3608, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "EXC MAL LES SCLP HND 1.1-2.0CM", "code_information": [ { "code": "11420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2823, "discounted_cash": 2480,"minimum": 526.49,"maximum": 12312,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1411.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1411, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 537.02, "standard_charge_percentage": 19.0200, "estimated_amount": 537, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 2823, "estimated_amount": 2823, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 2823, "estimated_amount": 2823, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 526.49, "standard_charge_percentage": 18.6500, "estimated_amount": 526, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 846.9, "standard_charge_percentage": 30.0000, "estimated_amount": 846, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 2823, "estimated_amount": 2823, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 2823, "estimated_amount": 2823, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 2823, "estimated_amount": 2823, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2823, "estimated_amount": 2823, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2823, "estimated_amount": 2823, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2258.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 2823, "estimated_amount": 2823, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 2213.23, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 2213.23, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2258.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 552.74, "standard_charge_percentage": 19.5800, "estimated_amount": 552, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 2823, "estimated_amount": 2823, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "CHANGE CYSTOSTOMY TUBE SIMPLE", "code_information": [ { "code": "11421", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2515.34, "discounted_cash": 1077,"minimum": 469.11,"maximum": 12335.3,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2012.27, "standard_charge_percentage": 80.0000, "estimated_amount": 2012, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7709.55, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7709, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2875.66, "standard_charge_percentage": 18.6500, "estimated_amount": 2875, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1257.67, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1257, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1972.03, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1972, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 478.49, "standard_charge_percentage": 19.0200, "estimated_amount": 478, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1972.03, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1972, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 469.11, "standard_charge_percentage": 18.6500, "estimated_amount": 469, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4625.73, "standard_charge_percentage": 30.0000, "estimated_amount": 4625, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2515.34, "estimated_amount": 2515, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 754.6, "standard_charge_percentage": 30.0000, "estimated_amount": 754, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 492.5, "standard_charge_percentage": 19.5800, "estimated_amount": 492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2012.27, "standard_charge_percentage": 80.0000, "estimated_amount": 2012, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2933.18, "standard_charge_percentage": 19.0200, "estimated_amount": 2933, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3019.06, "standard_charge_percentage": 19.5800, "estimated_amount": 3019, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12335.3, "standard_charge_percentage": 80.0000, "estimated_amount": 12335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12335.3, "standard_charge_percentage": 80.0000, "estimated_amount": 12335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" }]}]} , { "description": "EXC BEN LES H-F-N-SP 2.1-3.0CM", "code_information": [ { "code": "11422", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3108, "discounted_cash": 2480,"minimum": 579.64,"maximum": 12187.2,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3108, "estimated_amount": 3108, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 579.64, "standard_charge_percentage": 18.6500, "estimated_amount": 579, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 591.23, "standard_charge_percentage": 19.0200, "estimated_amount": 591, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 932.4, "standard_charge_percentage": 30.0000, "estimated_amount": 932, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12187.2, "standard_charge_percentage": 80.0000, "estimated_amount": 12187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2486.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2486, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 608.55, "standard_charge_percentage": 19.5800, "estimated_amount": 608, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3108, "estimated_amount": 3108, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3108, "estimated_amount": 3108, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 2436.67, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2436, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 2436.67, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2436, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3108, "estimated_amount": 3108, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3108, "estimated_amount": 3108, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3108, "estimated_amount": 3108, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4570.2, "standard_charge_percentage": 30.0000, "estimated_amount": 4570, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1554, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1554, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2486.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2486, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3108, "estimated_amount": 3108, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3108, "estimated_amount": 3108, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2841.14, "standard_charge_percentage": 18.6500, "estimated_amount": 2841, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2897.96, "standard_charge_percentage": 19.0200, "estimated_amount": 2897, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12187.2, "standard_charge_percentage": 80.0000, "estimated_amount": 12187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7617, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2982.82, "standard_charge_percentage": 19.5800, "estimated_amount": 2982, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "EXC LES ABD WALL SUBQ 3CM/>", "code_information": [ { "code": "11423", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6655.86, "discounted_cash": 2480,"minimum": 1241.32,"maximum": 12751.7,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3327.93, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3327, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12751.7, "standard_charge_percentage": 80.0000, "estimated_amount": 12751, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12751.7, "standard_charge_percentage": 80.0000, "estimated_amount": 12751, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1241.32, "standard_charge_percentage": 18.6500, "estimated_amount": 1241, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1266.14, "standard_charge_percentage": 19.0200, "estimated_amount": 1266, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5324.69, "standard_charge_percentage": 80.0000, "estimated_amount": 5324, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1996.76, "standard_charge_percentage": 30.0000, "estimated_amount": 1996, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1303.22, "standard_charge_percentage": 19.5800, "estimated_amount": 1303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3032.19, "standard_charge_percentage": 19.0200, "estimated_amount": 3032, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4781.88, "standard_charge_percentage": 30.0000, "estimated_amount": 4781, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5324.69, "standard_charge_percentage": 80.0000, "estimated_amount": 5324, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7969.8, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2972.74, "standard_charge_percentage": 18.6500, "estimated_amount": 2972, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3120.97, "standard_charge_percentage": 19.5800, "estimated_amount": 3120, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "Exc H-F-Nk-Sp B9+Marg 3.1-4", "code_information": [ { "code": "11424", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 2480,"minimum": 1526.47,"maximum": 12312,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" }]}]} , { "description": "Hc Exc Skin Benig >4 Cm Scalp/Neck/Hnd/Ft/Gent", "code_information": [ { "code": "11426", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4855.89, "discounted_cash": 4381,"minimum": 905.62,"maximum": 12312,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2427.95, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2427, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 905.62, "standard_charge_percentage": 18.6500, "estimated_amount": 905, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 4855.89, "estimated_amount": 4855, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 4855.89, "estimated_amount": 4855, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4855.89, "estimated_amount": 4855, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3807.02, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3807, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3884.71, "standard_charge_percentage": 80.0000, "estimated_amount": 3884, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4855.89, "estimated_amount": 4855, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4855.89, "estimated_amount": 4855, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4855.89, "estimated_amount": 4855, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3807.02, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3807, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 923.74, "standard_charge_percentage": 19.0200, "estimated_amount": 923, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1456.77, "standard_charge_percentage": 30.0000, "estimated_amount": 1456, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 950.78, "standard_charge_percentage": 19.5800, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3884.71, "standard_charge_percentage": 80.0000, "estimated_amount": 3884, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 4855.89, "estimated_amount": 4855, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 4855.89, "estimated_amount": 4855, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4855.89, "estimated_amount": 4855, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" }]}]} , { "description": "US GUIDED FNA BX 1ST LESION", "code_information": [ { "code": "11440", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2024, "discounted_cash": 1077,"minimum": 377.48,"maximum": 2024,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2024, "estimated_amount": 2024, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1586.82, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1586, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1586.82, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1586, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 396.3, "standard_charge_percentage": 19.5800, "estimated_amount": 396, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1012, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1012, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2024, "estimated_amount": 2024, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 377.48, "standard_charge_percentage": 18.6500, "estimated_amount": 377, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 385.03, "standard_charge_percentage": 19.0200, "estimated_amount": 385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1619.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1619, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 607.2, "standard_charge_percentage": 30.0000, "estimated_amount": 607, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1619.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1619, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" }]}]} , { "description": "US GUIDE FNA BX EA ADD LESION", "code_information": [ { "code": "11441", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1956, "discounted_cash": 1077,"minimum": 364.79,"maximum": 12312,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1956, "estimated_amount": 1956, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 978, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 372.09, "standard_charge_percentage": 19.0200, "estimated_amount": 372, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 382.98, "standard_charge_percentage": 19.5800, "estimated_amount": 382, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1564.8, "standard_charge_percentage": 80.0000, "estimated_amount": 1564, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1956, "estimated_amount": 1956, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1533.5, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1533, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1564.8, "standard_charge_percentage": 80.0000, "estimated_amount": 1564, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 364.79, "standard_charge_percentage": 18.6500, "estimated_amount": 364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1956, "estimated_amount": 1956, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1533.5, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1533, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 586.8, "standard_charge_percentage": 30.0000, "estimated_amount": 586, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" }]}]} , { "description": "FNA BX W/FLUOR GUID 1ST LESION", "code_information": [ { "code": "11442", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2588.16, "discounted_cash": 1077,"minimum": 482.69,"maximum": 12312,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 2029.12, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2029, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 492.35, "standard_charge_percentage": 19.0200, "estimated_amount": 492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2070.53, "standard_charge_percentage": 80.0000, "estimated_amount": 2070, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2070.53, "standard_charge_percentage": 80.0000, "estimated_amount": 2070, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2588.16, "estimated_amount": 2588, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 506.76, "standard_charge_percentage": 19.5800, "estimated_amount": 506, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1294.08, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1294, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 2029.12, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2029, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 482.69, "standard_charge_percentage": 18.6500, "estimated_amount": 482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 776.45, "standard_charge_percentage": 30.0000, "estimated_amount": 776, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" }]}]} , { "description": "FNA BX W/FLUOR GD ADDL LESION", "code_information": [ { "code": "11443", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2752, "discounted_cash": 2480,"minimum": 513.25,"maximum": 12312,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 2157.57, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2157, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 538.84, "standard_charge_percentage": 19.5800, "estimated_amount": 538, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 2752, "estimated_amount": 2752, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 2752, "estimated_amount": 2752, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2752, "estimated_amount": 2752, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1376, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1376, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2201.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2201, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 2752, "estimated_amount": 2752, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 2752, "estimated_amount": 2752, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2752, "estimated_amount": 2752, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2752, "estimated_amount": 2752, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 2157.57, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2157, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 513.25, "standard_charge_percentage": 18.6500, "estimated_amount": 513, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 523.51, "standard_charge_percentage": 19.0200, "estimated_amount": 523, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2201.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2201, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 825.6, "standard_charge_percentage": 30.0000, "estimated_amount": 825, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 2752, "estimated_amount": 2752, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 2752, "estimated_amount": 2752, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 2752, "estimated_amount": 2752, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "11444", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10260, "discounted_cash": 2480,"minimum": 1526.47,"maximum": 8208,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1951.76, "standard_charge_percentage": 19.0200, "estimated_amount": 1951, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3078, "standard_charge_percentage": 30.0000, "estimated_amount": 3078, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2008.91, "standard_charge_percentage": 19.5800, "estimated_amount": 2008, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5130, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1913.49, "standard_charge_percentage": 18.6500, "estimated_amount": 1913, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8208, "standard_charge_percentage": 80.0000, "estimated_amount": 8208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8208, "standard_charge_percentage": 80.0000, "estimated_amount": 8208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" }]}]} , { "description": "Exc skn hdrdnt ax smpl/ntrm", "code_information": [ { "code": "11450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18287.3, "discounted_cash": 4381,"minimum": 1715,"maximum": 14629.8,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5486.19, "standard_charge_percentage": 30.0000, "estimated_amount": 5486, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3580.65, "standard_charge_percentage": 19.5800, "estimated_amount": 3580, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14629.8, "standard_charge_percentage": 80.0000, "estimated_amount": 14629, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3410.58, "standard_charge_percentage": 18.6500, "estimated_amount": 3410, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3478.79, "standard_charge_percentage": 19.0200, "estimated_amount": 3478, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14629.8, "standard_charge_percentage": 80.0000, "estimated_amount": 14629, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" }]}]} , { "description": "Exc tr-ext mal+marg 1.1-2 cm", "code_information": [ { "code": "11602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 611,"minimum": 376.41,"maximum": 12312,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "11603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 1077,"minimum": 662.86,"maximum": 12312,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "11604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11115, "discounted_cash": 1077,"minimum": 662.86,"maximum": 8892,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2072.95, "standard_charge_percentage": 18.6500, "estimated_amount": 2072, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2176.32, "standard_charge_percentage": 19.5800, "estimated_amount": 2176, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2114.41, "standard_charge_percentage": 19.0200, "estimated_amount": 2114, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8892, "standard_charge_percentage": 80.0000, "estimated_amount": 8892, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3334.5, "standard_charge_percentage": 30.0000, "estimated_amount": 3334, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8892, "standard_charge_percentage": 80.0000, "estimated_amount": 8892, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5557.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5557, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "11606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7695, "discounted_cash": 2480,"minimum": 1435.12,"maximum": 6156,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1506.68, "standard_charge_percentage": 19.5800, "estimated_amount": 1506, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3847.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3847, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1435.12, "standard_charge_percentage": 18.6500, "estimated_amount": 1435, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6156, "standard_charge_percentage": 80.0000, "estimated_amount": 6156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2308.5, "standard_charge_percentage": 30.0000, "estimated_amount": 2308, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1463.82, "standard_charge_percentage": 19.0200, "estimated_amount": 1463, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6156, "standard_charge_percentage": 80.0000, "estimated_amount": 6156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "11624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 2480,"minimum": 1526.47,"maximum": 12312,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "11641", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5130, "discounted_cash": 1077,"minimum": 662.86,"maximum": 4104,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2565, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2565, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 975.88, "standard_charge_percentage": 19.0200, "estimated_amount": 975, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 956.74, "standard_charge_percentage": 18.6500, "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1004.45, "standard_charge_percentage": 19.5800, "estimated_amount": 1004, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4104, "standard_charge_percentage": 80.0000, "estimated_amount": 4104, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4021.92, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4021, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4021.92, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4021, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4104, "standard_charge_percentage": 80.0000, "estimated_amount": 4104, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1539, "standard_charge_percentage": 30.0000, "estimated_amount": 1539, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" }]}]} , { "description": "Hc Trim Nail(S)", "code_information": [ { "code": "11719", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 251.09, "discounted_cash": 90,"minimum": 46.83,"maximum": 251.09,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 251.09, "estimated_amount": 251, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 251.09, "estimated_amount": 251, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 47.76, "standard_charge_percentage": 19.0200, "estimated_amount": 47, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 75.33, "standard_charge_percentage": 30.0000, "estimated_amount": 75, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 55.96, "estimated_amount": 55, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 120.38, "estimated_amount": 120, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 139.9, "estimated_amount": 139, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 102.79, "estimated_amount": 102, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 125.55, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 125, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 200.87, "standard_charge_percentage": 80.0000, "estimated_amount": 200, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 97.93, "estimated_amount": 97, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 73.45, "estimated_amount": 73, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 148.29, "estimated_amount": 148, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 46.83, "standard_charge_percentage": 18.6500, "estimated_amount": 46, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 200.87, "standard_charge_percentage": 80.0000, "estimated_amount": 200, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 49.16, "standard_charge_percentage": 19.5800, "estimated_amount": 49, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 196.85, "standard_charge_percentage": 78.4000, "estimated_amount": 196, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 196.85, "standard_charge_percentage": 78.4000, "estimated_amount": 196, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 94.43, "estimated_amount": 94, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 111.92, "estimated_amount": 111, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 139.9, "estimated_amount": 139, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 148.29, "estimated_amount": 148, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 213.43, "standard_charge_percentage": 85.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 213.43, "standard_charge_percentage": 85.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 120.38, "estimated_amount": 120, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 120.38, "estimated_amount": 120, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" }]}]} , { "description": "CYSTOSCOPY CHEMODENERVATION", "code_information": [ { "code": "11720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 237.17, "discounted_cash": 90,"minimum": 44.23,"maximum": 237.17,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 71.15, "standard_charge_percentage": 30.0000, "estimated_amount": 71, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 94.43, "estimated_amount": 94, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 55.96, "estimated_amount": 55, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 139.9, "estimated_amount": 139, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 148.29, "estimated_amount": 148, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 237.17, "estimated_amount": 237, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 185.94, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 185, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 185.94, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 185, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 45.12, "standard_charge_percentage": 19.0200, "estimated_amount": 45, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 189.74, "standard_charge_percentage": 80.0000, "estimated_amount": 189, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 46.44, "standard_charge_percentage": 19.5800, "estimated_amount": 46, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 139.9, "estimated_amount": 139, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 237.17, "estimated_amount": 237, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 118.58, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 118, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 237.17, "estimated_amount": 237, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 237.17, "estimated_amount": 237, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 189.74, "standard_charge_percentage": 80.0000, "estimated_amount": 189, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 120.38, "estimated_amount": 120, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 111.92, "estimated_amount": 111, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 97.93, "estimated_amount": 97, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 44.23, "standard_charge_percentage": 18.6500, "estimated_amount": 44, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 120.38, "estimated_amount": 120, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 120.38, "estimated_amount": 120, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 102.79, "estimated_amount": 102, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 73.45, "estimated_amount": 73, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 148.29, "estimated_amount": 148, "methodology": "fee schedule" }]}]} , { "description": "Hc Debridement Of Nails, 6 Or More", "code_information": [ { "code": "11721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 326, "discounted_cash": 90,"minimum": 55.96,"maximum": 326,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 163, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 163, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 62.01, "standard_charge_percentage": 19.0200, "estimated_amount": 62, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 97.8, "standard_charge_percentage": 30.0000, "estimated_amount": 97, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 260.8, "standard_charge_percentage": 80.0000, "estimated_amount": 260, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 111.92, "estimated_amount": 111, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 97.93, "estimated_amount": 97, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 73.45, "estimated_amount": 73, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 326, "estimated_amount": 326, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 255.58, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 255, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 120.38, "estimated_amount": 120, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 139.9, "estimated_amount": 139, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 148.29, "estimated_amount": 148, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 326, "estimated_amount": 326, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 94.43, "estimated_amount": 94, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 55.96, "estimated_amount": 55, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 120.38, "estimated_amount": 120, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 139.9, "estimated_amount": 139, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 326, "estimated_amount": 326, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 326, "estimated_amount": 326, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 255.58, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 255, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 60.8, "standard_charge_percentage": 18.6500, "estimated_amount": 60, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 260.8, "standard_charge_percentage": 80.0000, "estimated_amount": 260, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 63.83, "standard_charge_percentage": 19.5800, "estimated_amount": 63, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 120.38, "estimated_amount": 120, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 102.79, "estimated_amount": 102, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 148.29, "estimated_amount": 148, "methodology": "fee schedule" }]}]} , { "description": "Hc Removal Of Nail Plate", "code_information": [ { "code": "11730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 821.86, "discounted_cash": 304,"minimum": 153.28,"maximum": 821.86,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 246.56, "standard_charge_percentage": 30.0000, "estimated_amount": 246, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 245.7, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 156.34, "standard_charge_percentage": 19.0200, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 657.49, "standard_charge_percentage": 80.0000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 187.2, "estimated_amount": 187, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 343.86, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 410.93, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 410, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 644.34, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 657.49, "standard_charge_percentage": 80.0000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 374.4, "estimated_amount": 374, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 644.34, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 153.28, "standard_charge_percentage": 18.6500, "estimated_amount": 153, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 160.92, "standard_charge_percentage": 19.5800, "estimated_amount": 160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 315.9, "estimated_amount": 315, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" }]}]} , { "description": "Hc Removal Of Nail Plate, Simple, Ea Ad", "code_information": [ { "code": "11732", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 746.75,"minimum": 139.27,"maximum": 746.75,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 746.75, "estimated_amount": 746, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 373.38, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 373, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 585.45, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 585, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 142.05, "standard_charge_percentage": 19.0200, "estimated_amount": 142, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 746.75, "estimated_amount": 746, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 597.4, "standard_charge_percentage": 80.0000, "estimated_amount": 597, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 224.03, "standard_charge_percentage": 30.0000, "estimated_amount": 224, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 146.21, "standard_charge_percentage": 19.5800, "estimated_amount": 146, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 746.75, "estimated_amount": 746, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 746.75, "estimated_amount": 746, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 585.45, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 139.27, "standard_charge_percentage": 18.6500, "estimated_amount": 139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 597.4, "standard_charge_percentage": 80.0000, "estimated_amount": 597, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Drain Blood From Under Nail", "code_information": [ { "code": "11740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 524.41, "discounted_cash": 197,"minimum": 97.8,"maximum": 524.41,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 411.14, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 97.8, "standard_charge_percentage": 18.6500, "estimated_amount": 97, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 419.53, "standard_charge_percentage": 80.0000, "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 157.32, "standard_charge_percentage": 30.0000, "estimated_amount": 157, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 419.53, "standard_charge_percentage": 80.0000, "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 321.82, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 524.41, "estimated_amount": 524, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 99.76, "standard_charge_percentage": 19.0200, "estimated_amount": 99, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 102.68, "standard_charge_percentage": 19.5800, "estimated_amount": 102, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 303.6, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 524.41, "estimated_amount": 524, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 262.2, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 262, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 204.93, "estimated_amount": 204, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 121.44, "estimated_amount": 121, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 303.6, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 321.82, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 524.41, "estimated_amount": 524, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 524.41, "estimated_amount": 524, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 411.14, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 242.88, "estimated_amount": 242, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 212.52, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 223.07, "estimated_amount": 223, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 159.39, "estimated_amount": 159, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" }]}]} , { "description": "Hc Removal Of Nail Bed", "code_information": [ { "code": "11750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2182.8, "discounted_cash": 611,"minimum": 376.41,"maximum": 13464,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8415, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8415, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3138.8, "standard_charge_percentage": 18.6500, "estimated_amount": 3138, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13464, "standard_charge_percentage": 80.0000, "estimated_amount": 13464, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5049, "standard_charge_percentage": 30.0000, "estimated_amount": 5049, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2182.8, "estimated_amount": 2182, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1746.24, "standard_charge_percentage": 80.0000, "estimated_amount": 1746, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1091.4, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1091, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1746.24, "standard_charge_percentage": 80.0000, "estimated_amount": 1746, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 427.39, "standard_charge_percentage": 19.5800, "estimated_amount": 427, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3201.57, "standard_charge_percentage": 19.0200, "estimated_amount": 3201, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3295.31, "standard_charge_percentage": 19.5800, "estimated_amount": 3295, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2182.8, "estimated_amount": 2182, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1711.32, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1711, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1711.32, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1711, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 407.09, "standard_charge_percentage": 18.6500, "estimated_amount": 407, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 415.23, "standard_charge_percentage": 19.0200, "estimated_amount": 415, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 654.84, "standard_charge_percentage": 30.0000, "estimated_amount": 654, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13464, "standard_charge_percentage": 80.0000, "estimated_amount": 13464, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" }]}]} , { "description": "Hc Biopsy, Nail Unit (Sep Proc)", "code_information": [ { "code": "11755", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2147, "discounted_cash": 1077,"minimum": 400.42,"maximum": 2147,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1073.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1073, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 408.42, "standard_charge_percentage": 19.0200, "estimated_amount": 408, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1717.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1717, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 420.38, "standard_charge_percentage": 19.5800, "estimated_amount": 420, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1717.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1717, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2147, "estimated_amount": 2147, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2147, "estimated_amount": 2147, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1683.25, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1683, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1683.25, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1683, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 400.42, "standard_charge_percentage": 18.6500, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 644.1, "standard_charge_percentage": 30.0000, "estimated_amount": 644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" }]}]} , { "description": "Hc Reconstruc Of Nail Bed", "code_information": [ { "code": "11760", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2578.33, "discounted_cash": 937,"minimum": 480.86,"maximum": 12312,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 2021.41, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2021, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 490.48, "standard_charge_percentage": 19.0200, "estimated_amount": 490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1153.41, "estimated_amount": 1153, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 576.7, "estimated_amount": 576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1009.23, "estimated_amount": 1009, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2578.33, "estimated_amount": 2578, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1289.16, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1289, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 2021.41, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2021, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 576.7, "estimated_amount": 576, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 480.86, "standard_charge_percentage": 18.6500, "estimated_amount": 480, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 504.84, "standard_charge_percentage": 19.5800, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1009.23, "estimated_amount": 1009, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2062.66, "standard_charge_percentage": 80.0000, "estimated_amount": 2062, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 773.5, "standard_charge_percentage": 30.0000, "estimated_amount": 773, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2062.66, "standard_charge_percentage": 80.0000, "estimated_amount": 2062, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 973.19, "estimated_amount": 973, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1059.33, "estimated_amount": 1059, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 756.92, "estimated_amount": 756, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 973.19, "estimated_amount": 973, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1153.41, "estimated_amount": 1153, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1059.33, "estimated_amount": 1059, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 756.92, "estimated_amount": 756, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" }]}]} , { "description": "Hc Excision Of Nail Fold (Wedge), Toe", "code_information": [ { "code": "11765", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1170.71, "discounted_cash": 611,"minimum": 218.34,"maximum": 1170.71,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 222.7, "standard_charge_percentage": 19.0200, "estimated_amount": 222, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 936.57, "standard_charge_percentage": 80.0000, "estimated_amount": 936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 585.36, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 917.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 917.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 218.34, "standard_charge_percentage": 18.6500, "estimated_amount": 218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 351.21, "standard_charge_percentage": 30.0000, "estimated_amount": 351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 229.23, "standard_charge_percentage": 19.5800, "estimated_amount": 229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 936.57, "standard_charge_percentage": 80.0000, "estimated_amount": 936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" }]}]} , { "description": "Remove Pilonidal Cyst Simple", "code_information": [ { "code": "11770", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 4381,"minimum": 1715,"maximum": 12312,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" }]}]} , { "description": "Remove pilonidal cyst exten", "code_information": [ { "code": "11771", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25003.9, "discounted_cash": 4381,"minimum": 1715,"maximum": 20003.1,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 20003.1, "standard_charge_percentage": 80.0000, "estimated_amount": 20003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4895.76, "standard_charge_percentage": 19.5800, "estimated_amount": 4895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4756.49, "standard_charge_percentage": 19.0200, "estimated_amount": 4756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4663.23, "standard_charge_percentage": 18.6500, "estimated_amount": 4663, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7501.17, "standard_charge_percentage": 30.0000, "estimated_amount": 7501, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 20003.1, "standard_charge_percentage": 80.0000, "estimated_amount": 20003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" }]}]} , { "description": "Remove pilonidal cyst compl", "code_information": [ { "code": "11772", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26568.8, "discounted_cash": 4381,"minimum": 1715,"maximum": 21255,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 21255, "standard_charge_percentage": 80.0000, "estimated_amount": 21255, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7970.64, "standard_charge_percentage": 30.0000, "estimated_amount": 7970, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5202.17, "standard_charge_percentage": 19.5800, "estimated_amount": 5202, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4955.08, "standard_charge_percentage": 18.6500, "estimated_amount": 4955, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 21255, "standard_charge_percentage": 80.0000, "estimated_amount": 21255, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5054.18, "standard_charge_percentage": 19.0200, "estimated_amount": 5054, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" }]}]} , { "description": "Hc Inject Skin Lesions 7 Lesions", "code_information": [ { "code": "11901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 236.67, "discounted_cash": 304,"minimum": 44.14,"maximum": 236.67,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 236.67, "estimated_amount": 236, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 185.55, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 185, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 44.14, "standard_charge_percentage": 18.6500, "estimated_amount": 44, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 189.34, "standard_charge_percentage": 80.0000, "estimated_amount": 189, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 236.67, "estimated_amount": 236, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 189.34, "standard_charge_percentage": 80.0000, "estimated_amount": 189, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 46.34, "standard_charge_percentage": 19.5800, "estimated_amount": 46, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 236.67, "estimated_amount": 236, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 118.33, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 118, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 236.67, "estimated_amount": 236, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 236.67, "estimated_amount": 236, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 187.2, "estimated_amount": 187, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 236.67, "estimated_amount": 236, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 236.67, "estimated_amount": 236, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 236.67, "estimated_amount": 236, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 236.67, "estimated_amount": 236, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 236.67, "estimated_amount": 236, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 236.67, "estimated_amount": 236, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 185.55, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 185, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 45.02, "standard_charge_percentage": 19.0200, "estimated_amount": 45, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 71, "standard_charge_percentage": 30.0000, "estimated_amount": 71, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 236.67, "estimated_amount": 236, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 236.67, "estimated_amount": 236, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 236.67, "estimated_amount": 236, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 236.67, "estimated_amount": 236, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 236.67, "estimated_amount": 236, "methodology": "fee schedule" }]}]} , { "description": "Hc Removal Tissue Expander W/O Insertion Implant", "code_information": [ { "code": "11971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11850, "discounted_cash": 4381,"minimum": 1715,"maximum": 9480,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5925, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5925, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2210.02, "standard_charge_percentage": 18.6500, "estimated_amount": 2210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9480, "standard_charge_percentage": 80.0000, "estimated_amount": 9480, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3555, "standard_charge_percentage": 30.0000, "estimated_amount": 3555, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9480, "standard_charge_percentage": 80.0000, "estimated_amount": 9480, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2254.23, "standard_charge_percentage": 19.0200, "estimated_amount": 2254, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2320.23, "standard_charge_percentage": 19.5800, "estimated_amount": 2320, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" }]}]} , { "description": "Remove Contraceptive Capsule", "code_information": [ { "code": "11976", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 1077,"minimum": 662.86,"maximum": 12312,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "11981", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24260.6, "discounted_cash": 197,"minimum": 121.44,"maximum": 19408.5,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4750.23, "standard_charge_percentage": 19.5800, "estimated_amount": 4750, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 303.6, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4615.09, "standard_charge_percentage": 19.0200, "estimated_amount": 4615, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7278.18, "standard_charge_percentage": 30.0000, "estimated_amount": 7278, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 204.93, "estimated_amount": 204, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 121.44, "estimated_amount": 121, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 242.88, "estimated_amount": 242, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 212.52, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 303.6, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 159.39, "estimated_amount": 159, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 321.82, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 19408.5, "standard_charge_percentage": 80.0000, "estimated_amount": 19408, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 223.07, "estimated_amount": 223, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4524.6, "standard_charge_percentage": 18.6500, "estimated_amount": 4524, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 19408.5, "standard_charge_percentage": 80.0000, "estimated_amount": 19408, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 321.82, "estimated_amount": 321, "methodology": "fee schedule" }]}]} , { "description": "Remove drug implant device", "code_information": [ { "code": "11982", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 610,"minimum": 375.94,"maximum": 12312,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 634.41, "estimated_amount": 634, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 469.93, "estimated_amount": 469, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 690.56, "estimated_amount": 690, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 469.93, "estimated_amount": 469, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 469.93, "estimated_amount": 469, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 808.75, "estimated_amount": 808, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 939.86, "estimated_amount": 939, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 493.43, "estimated_amount": 493, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 469.93, "estimated_amount": 469, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 469.93, "estimated_amount": 469, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 375.94, "estimated_amount": 375, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 469.93, "estimated_amount": 469, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 808.75, "estimated_amount": 808, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 751.89, "estimated_amount": 751, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 939.86, "estimated_amount": 939, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 996.25, "estimated_amount": 996, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 996.25, "estimated_amount": 996, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 469.93, "estimated_amount": 469, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 808.75, "estimated_amount": 808, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 657.9, "estimated_amount": 657, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 469.93, "estimated_amount": 469, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 469.93, "estimated_amount": 469, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 469.93, "estimated_amount": 469, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Smp Body/Scalp/Extr <2.5 Cm", "code_information": [ { "code": "12001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 821.86, "discounted_cash": 304,"minimum": 153.28,"maximum": 821.86,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 153.28, "standard_charge_percentage": 18.6500, "estimated_amount": 153, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 246.56, "standard_charge_percentage": 30.0000, "estimated_amount": 246, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 187.2, "estimated_amount": 187, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 343.86, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 410.93, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 410, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 644.34, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 160.92, "standard_charge_percentage": 19.5800, "estimated_amount": 160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 156.34, "standard_charge_percentage": 19.0200, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 657.49, "standard_charge_percentage": 80.0000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 657.49, "standard_charge_percentage": 80.0000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 374.4, "estimated_amount": 374, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 644.34, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 315.9, "estimated_amount": 315, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 245.7, "estimated_amount": 245, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Smp Body/Scalp/Extr 2.6-7.5 Cm", "code_information": [ { "code": "12002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 821.86, "discounted_cash": 304,"minimum": 153.28,"maximum": 821.86,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 153.28, "standard_charge_percentage": 18.6500, "estimated_amount": 153, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 657.49, "standard_charge_percentage": 80.0000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 410.93, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 410, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 644.34, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 644.34, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 187.2, "estimated_amount": 187, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 343.86, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 156.34, "standard_charge_percentage": 19.0200, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 657.49, "standard_charge_percentage": 80.0000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 246.56, "standard_charge_percentage": 30.0000, "estimated_amount": 246, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 160.92, "standard_charge_percentage": 19.5800, "estimated_amount": 160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 315.9, "estimated_amount": 315, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 245.7, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 374.4, "estimated_amount": 374, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Smp Body/Scalp/Extr 7.6-12.5 Cm", "code_information": [ { "code": "12004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2000, "discounted_cash": 304,"minimum": 187.2,"maximum": 2000,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1568, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1568, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1568, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1568, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 373, "standard_charge_percentage": 18.6500, "estimated_amount": 373, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1600, "standard_charge_percentage": 80.0000, "estimated_amount": 1600, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 600, "standard_charge_percentage": 30.0000, "estimated_amount": 600, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 391.6, "standard_charge_percentage": 19.5800, "estimated_amount": 391, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 343.86, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 380.46, "standard_charge_percentage": 19.0200, "estimated_amount": 380, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2000, "estimated_amount": 2000, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 315.9, "estimated_amount": 315, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 187.2, "estimated_amount": 187, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 245.7, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2000, "estimated_amount": 2000, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1000, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1600, "standard_charge_percentage": 80.0000, "estimated_amount": 1600, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 374.4, "estimated_amount": 374, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Smp Body/Scalp/Extr 12.6-20 Cm", "code_information": [ { "code": "12005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1170.71, "discounted_cash": 611,"minimum": 218.34,"maximum": 1170.71,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 917.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 917.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 218.34, "standard_charge_percentage": 18.6500, "estimated_amount": 218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 936.57, "standard_charge_percentage": 80.0000, "estimated_amount": 936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 351.21, "standard_charge_percentage": 30.0000, "estimated_amount": 351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 229.23, "standard_charge_percentage": 19.5800, "estimated_amount": 229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 585.36, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 936.57, "standard_charge_percentage": 80.0000, "estimated_amount": 936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 222.7, "standard_charge_percentage": 19.0200, "estimated_amount": 222, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Smp Body/Scalp/Extr 20.1-30 Cm", "code_information": [ { "code": "12006", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1765, "discounted_cash": 611,"minimum": 329.17,"maximum": 1765,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 529.5, "standard_charge_percentage": 30.0000, "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 345.59, "standard_charge_percentage": 19.5800, "estimated_amount": 345, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1412, "standard_charge_percentage": 80.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1765, "estimated_amount": 1765, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1765, "estimated_amount": 1765, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 882.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 882, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 335.76, "standard_charge_percentage": 19.0200, "estimated_amount": 335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1765, "estimated_amount": 1765, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1383.76, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1383, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 329.17, "standard_charge_percentage": 18.6500, "estimated_amount": 329, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1383.76, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1383, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1412, "standard_charge_percentage": 80.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Smp Body/Scalp/Extr >30.1 Cm", "code_information": [ { "code": "12007", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 657.7, "discounted_cash": 304,"minimum": 122.66,"maximum": 657.7,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 657.7, "estimated_amount": 657, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 197.31, "standard_charge_percentage": 30.0000, "estimated_amount": 197, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 128.78, "standard_charge_percentage": 19.5800, "estimated_amount": 128, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 526.16, "standard_charge_percentage": 80.0000, "estimated_amount": 526, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 374.4, "estimated_amount": 374, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 328.85, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 328, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 657.7, "estimated_amount": 657, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 515.64, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 515.64, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 122.66, "standard_charge_percentage": 18.6500, "estimated_amount": 122, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 315.9, "estimated_amount": 315, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 187.2, "estimated_amount": 187, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 245.7, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 125.11, "standard_charge_percentage": 19.0200, "estimated_amount": 125, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 657.7, "estimated_amount": 657, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 657.7, "estimated_amount": 657, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 526.16, "standard_charge_percentage": 80.0000, "estimated_amount": 526, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 343.86, "estimated_amount": 343, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Smp Face 2.6-5.0 Cm", "code_information": [ { "code": "12013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 821.86, "discounted_cash": 304,"minimum": 153.28,"maximum": 821.86,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 410.93, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 410, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 156.34, "standard_charge_percentage": 19.0200, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 657.49, "standard_charge_percentage": 80.0000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 657.49, "standard_charge_percentage": 80.0000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 374.4, "estimated_amount": 374, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 343.86, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 644.34, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 153.28, "standard_charge_percentage": 18.6500, "estimated_amount": 153, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 246.56, "standard_charge_percentage": 30.0000, "estimated_amount": 246, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 315.9, "estimated_amount": 315, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 644.34, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 187.2, "estimated_amount": 187, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 245.7, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 160.92, "standard_charge_percentage": 19.5800, "estimated_amount": 160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Smp Face 5.1-7.5 Cm", "code_information": [ { "code": "12014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 821.86, "discounted_cash": 304,"minimum": 153.28,"maximum": 821.86,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 410.93, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 410, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 644.34, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 644.34, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 374.4, "estimated_amount": 374, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 343.86, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 153.28, "standard_charge_percentage": 18.6500, "estimated_amount": 153, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 156.34, "standard_charge_percentage": 19.0200, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 657.49, "standard_charge_percentage": 80.0000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 315.9, "estimated_amount": 315, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 657.49, "standard_charge_percentage": 80.0000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 246.56, "standard_charge_percentage": 30.0000, "estimated_amount": 246, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 160.92, "standard_charge_percentage": 19.5800, "estimated_amount": 160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 187.2, "estimated_amount": 187, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 245.7, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Smp Face 7.6-12.5 Cm", "code_information": [ { "code": "12015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 657.7, "discounted_cash": 304,"minimum": 122.66,"maximum": 657.7,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 328.85, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 328, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 657.7, "estimated_amount": 657, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 197.31, "standard_charge_percentage": 30.0000, "estimated_amount": 197, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 526.16, "standard_charge_percentage": 80.0000, "estimated_amount": 526, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 515.64, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 122.66, "standard_charge_percentage": 18.6500, "estimated_amount": 122, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 343.86, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 657.7, "estimated_amount": 657, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 657.7, "estimated_amount": 657, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 657.7, "estimated_amount": 657, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 515.64, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 526.16, "standard_charge_percentage": 80.0000, "estimated_amount": 526, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 128.78, "standard_charge_percentage": 19.5800, "estimated_amount": 128, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 374.4, "estimated_amount": 374, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 125.11, "standard_charge_percentage": 19.0200, "estimated_amount": 125, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 315.9, "estimated_amount": 315, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 187.2, "estimated_amount": 187, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 245.7, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Smp Face 12.6-20 Cm", "code_information": [ { "code": "12016", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1170.71, "discounted_cash": 611,"minimum": 218.34,"maximum": 1170.71,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 936.57, "standard_charge_percentage": 80.0000, "estimated_amount": 936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 917.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 917.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 218.34, "standard_charge_percentage": 18.6500, "estimated_amount": 218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 585.36, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 229.23, "standard_charge_percentage": 19.5800, "estimated_amount": 229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 936.57, "standard_charge_percentage": 80.0000, "estimated_amount": 936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 222.7, "standard_charge_percentage": 19.0200, "estimated_amount": 222, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 351.21, "standard_charge_percentage": 30.0000, "estimated_amount": 351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Smp Face 20.1-30 Cm", "code_information": [ { "code": "12017", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1170.71, "discounted_cash": 611,"minimum": 218.34,"maximum": 1170.71,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 351.21, "standard_charge_percentage": 30.0000, "estimated_amount": 351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 229.23, "standard_charge_percentage": 19.5800, "estimated_amount": 229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 936.57, "standard_charge_percentage": 80.0000, "estimated_amount": 936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 917.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 585.36, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 218.34, "standard_charge_percentage": 18.6500, "estimated_amount": 218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 917.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 222.7, "standard_charge_percentage": 19.0200, "estimated_amount": 222, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 936.57, "standard_charge_percentage": 80.0000, "estimated_amount": 936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Smp Face >30.1 Cm", "code_information": [ { "code": "12018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 657.7, "discounted_cash": 304,"minimum": 122.66,"maximum": 657.7,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 657.7, "estimated_amount": 657, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 515.64, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 122.66, "standard_charge_percentage": 18.6500, "estimated_amount": 122, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 343.86, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 657.7, "estimated_amount": 657, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 197.31, "standard_charge_percentage": 30.0000, "estimated_amount": 197, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 526.16, "standard_charge_percentage": 80.0000, "estimated_amount": 526, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 125.11, "standard_charge_percentage": 19.0200, "estimated_amount": 125, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 315.9, "estimated_amount": 315, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 187.2, "estimated_amount": 187, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 245.7, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 657.7, "estimated_amount": 657, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 657.7, "estimated_amount": 657, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 328.85, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 328, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 515.64, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 526.16, "standard_charge_percentage": 80.0000, "estimated_amount": 526, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 128.78, "standard_charge_percentage": 19.5800, "estimated_amount": 128, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 374.4, "estimated_amount": 374, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" }]}]} , { "description": "Hc Treat Wnd Dehiscence, Simple Closure", "code_information": [ { "code": "12020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1799.94, "discounted_cash": 937,"minimum": 335.69,"maximum": 13848,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1411.15, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 576.7, "estimated_amount": 576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1009.23, "estimated_amount": 1009, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8655, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3228.32, "standard_charge_percentage": 18.6500, "estimated_amount": 3228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5193, "standard_charge_percentage": 30.0000, "estimated_amount": 5193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 973.19, "estimated_amount": 973, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1059.33, "estimated_amount": 1059, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 756.92, "estimated_amount": 756, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1411.15, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 756.92, "estimated_amount": 756, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1799.94, "estimated_amount": 1799, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1799.94, "estimated_amount": 1799, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 899.97, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 899, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1799.94, "estimated_amount": 1799, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 335.69, "standard_charge_percentage": 18.6500, "estimated_amount": 335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1439.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1153.41, "estimated_amount": 1153, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 342.4, "standard_charge_percentage": 19.0200, "estimated_amount": 342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 539.98, "standard_charge_percentage": 30.0000, "estimated_amount": 539, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 352.43, "standard_charge_percentage": 19.5800, "estimated_amount": 352, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1439.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 973.19, "estimated_amount": 973, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1153.41, "estimated_amount": 1153, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1059.33, "estimated_amount": 1059, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3292.88, "standard_charge_percentage": 19.0200, "estimated_amount": 3292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3389.3, "standard_charge_percentage": 19.5800, "estimated_amount": 3389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 576.7, "estimated_amount": 576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1009.23, "estimated_amount": 1009, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Intrmd Body/Scalp/Extr <2.5 Cm", "code_information": [ { "code": "12031", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1636.94, "discounted_cash": 611,"minimum": 305.29,"maximum": 1636.94,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1309.55, "standard_charge_percentage": 80.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1309.55, "standard_charge_percentage": 80.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 305.29, "standard_charge_percentage": 18.6500, "estimated_amount": 305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 320.51, "standard_charge_percentage": 19.5800, "estimated_amount": 320, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1283.36, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1283, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 311.4, "standard_charge_percentage": 19.0200, "estimated_amount": 311, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 818.47, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 818, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1283.36, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 491.08, "standard_charge_percentage": 30.0000, "estimated_amount": 491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Intrmd Body/Scalp/Extr 2.6-7.5 Cm", "code_information": [ { "code": "12032", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1636.94, "discounted_cash": 611,"minimum": 305.29,"maximum": 1636.94,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 818.47, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 818, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1283.36, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1283.36, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1283, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 311.4, "standard_charge_percentage": 19.0200, "estimated_amount": 311, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 305.29, "standard_charge_percentage": 18.6500, "estimated_amount": 305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1309.55, "standard_charge_percentage": 80.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 491.08, "standard_charge_percentage": 30.0000, "estimated_amount": 491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 320.51, "standard_charge_percentage": 19.5800, "estimated_amount": 320, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1309.55, "standard_charge_percentage": 80.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Intrmd Body/Scalp/Extr 7.6-12.5 Cm", "code_information": [ { "code": "12034", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1170.71, "discounted_cash": 611,"minimum": 218.34,"maximum": 1170.71,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 351.21, "standard_charge_percentage": 30.0000, "estimated_amount": 351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 917.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 917.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 218.34, "standard_charge_percentage": 18.6500, "estimated_amount": 218, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 222.7, "standard_charge_percentage": 19.0200, "estimated_amount": 222, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 585.36, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 229.23, "standard_charge_percentage": 19.5800, "estimated_amount": 229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 936.57, "standard_charge_percentage": 80.0000, "estimated_amount": 936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 936.57, "standard_charge_percentage": 80.0000, "estimated_amount": 936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Intrmd Body/Scalp/Extr 12.5-20 Cm", "code_information": [ { "code": "12035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1170.71, "discounted_cash": 611,"minimum": 218.34,"maximum": 1170.71,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 222.7, "standard_charge_percentage": 19.0200, "estimated_amount": 222, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 936.57, "standard_charge_percentage": 80.0000, "estimated_amount": 936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 229.23, "standard_charge_percentage": 19.5800, "estimated_amount": 229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 936.57, "standard_charge_percentage": 80.0000, "estimated_amount": 936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 917.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 917.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 585.36, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 218.34, "standard_charge_percentage": 18.6500, "estimated_amount": 218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 351.21, "standard_charge_percentage": 30.0000, "estimated_amount": 351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Intrmd Body/Scalp/Extr 20.1-30 Cm", "code_information": [ { "code": "12036", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1799.94, "discounted_cash": 937,"minimum": 335.69,"maximum": 1799.94,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1799.94, "estimated_amount": 1799, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1439.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 352.43, "standard_charge_percentage": 19.5800, "estimated_amount": 352, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1009.23, "estimated_amount": 1009, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1411.15, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1411, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 342.4, "standard_charge_percentage": 19.0200, "estimated_amount": 342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1059.33, "estimated_amount": 1059, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 756.92, "estimated_amount": 756, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1799.94, "estimated_amount": 1799, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 899.97, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 899, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1799.94, "estimated_amount": 1799, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1411.15, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 335.69, "standard_charge_percentage": 18.6500, "estimated_amount": 335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 539.98, "standard_charge_percentage": 30.0000, "estimated_amount": 539, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1439.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 973.19, "estimated_amount": 973, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 576.7, "estimated_amount": 576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1153.41, "estimated_amount": 1153, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Intrmd Body/Scalp/Extr >30.1 Cm", "code_information": [ { "code": "12037", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5773.63, "discounted_cash": 2800,"minimum": 1076.78,"maximum": 4618.9,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2886.82, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2886, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1076.78, "standard_charge_percentage": 18.6500, "estimated_amount": 1076, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1098.32, "standard_charge_percentage": 19.0200, "estimated_amount": 1098, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4618.9, "standard_charge_percentage": 80.0000, "estimated_amount": 4618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1732.09, "standard_charge_percentage": 30.0000, "estimated_amount": 1732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4618.9, "standard_charge_percentage": 80.0000, "estimated_amount": 4618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3446.74, "estimated_amount": 3446, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3015.89, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4526.53, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4526, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1723.37, "estimated_amount": 1723, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2261.92, "estimated_amount": 2261, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4526.53, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4526, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1130.48, "standard_charge_percentage": 19.5800, "estimated_amount": 1130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2908.18, "estimated_amount": 2908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3165.61, "estimated_amount": 3165, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Intrmd Neck/Hnd/Ft/Gent <2.5 Cm", "code_information": [ { "code": "12041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1170.71, "discounted_cash": 611,"minimum": 218.34,"maximum": 1170.71,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 585.36, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 917.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 917.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 218.34, "standard_charge_percentage": 18.6500, "estimated_amount": 218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 222.7, "standard_charge_percentage": 19.0200, "estimated_amount": 222, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 936.57, "standard_charge_percentage": 80.0000, "estimated_amount": 936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 351.21, "standard_charge_percentage": 30.0000, "estimated_amount": 351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 229.23, "standard_charge_percentage": 19.5800, "estimated_amount": 229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 936.57, "standard_charge_percentage": 80.0000, "estimated_amount": 936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Intrmd Neck/Hnd/Ft/Gent 2.6-7.5 Cm", "code_information": [ { "code": "12042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1636.94, "discounted_cash": 611,"minimum": 305.29,"maximum": 1636.94,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1309.55, "standard_charge_percentage": 80.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 491.08, "standard_charge_percentage": 30.0000, "estimated_amount": 491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1309.55, "standard_charge_percentage": 80.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 818.47, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 818, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 320.51, "standard_charge_percentage": 19.5800, "estimated_amount": 320, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1283.36, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 305.29, "standard_charge_percentage": 18.6500, "estimated_amount": 305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1283.36, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1283, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 311.4, "standard_charge_percentage": 19.0200, "estimated_amount": 311, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Intrmd Neck/Hnd/Ft/Gent 7.6-12.5 Cm", "code_information": [ { "code": "12044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1799.94, "discounted_cash": 937,"minimum": 335.69,"maximum": 1799.94,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1799.94, "estimated_amount": 1799, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1439.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 335.69, "standard_charge_percentage": 18.6500, "estimated_amount": 335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1439.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1153.41, "estimated_amount": 1153, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 756.92, "estimated_amount": 756, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 342.4, "standard_charge_percentage": 19.0200, "estimated_amount": 342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 539.98, "standard_charge_percentage": 30.0000, "estimated_amount": 539, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 352.43, "standard_charge_percentage": 19.5800, "estimated_amount": 352, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1009.23, "estimated_amount": 1009, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1799.94, "estimated_amount": 1799, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1799.94, "estimated_amount": 1799, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 899.97, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 899, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1411.15, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1411.15, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 973.19, "estimated_amount": 973, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 576.7, "estimated_amount": 576, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1059.33, "estimated_amount": 1059, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Intrmd Neck/Hnd/Ft/Gent 12.5-20 Cm", "code_information": [ { "code": "12045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1799.94, "discounted_cash": 937,"minimum": 335.69,"maximum": 1799.94,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1799.94, "estimated_amount": 1799, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1439.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 352.43, "standard_charge_percentage": 19.5800, "estimated_amount": 352, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1411.15, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1411, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 342.4, "standard_charge_percentage": 19.0200, "estimated_amount": 342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1153.41, "estimated_amount": 1153, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 756.92, "estimated_amount": 756, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1799.94, "estimated_amount": 1799, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 899.97, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 899, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1799.94, "estimated_amount": 1799, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1411.15, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1009.23, "estimated_amount": 1009, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 335.69, "standard_charge_percentage": 18.6500, "estimated_amount": 335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 539.98, "standard_charge_percentage": 30.0000, "estimated_amount": 539, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1439.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 973.19, "estimated_amount": 973, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 576.7, "estimated_amount": 576, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1059.33, "estimated_amount": 1059, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Intrmd Neck/Hnd/Ft/Gent 20.1-30 Cm", "code_information": [ { "code": "12046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1170.71, "discounted_cash": 937,"minimum": 218.34,"maximum": 1170.71,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 936.57, "standard_charge_percentage": 80.0000, "estimated_amount": 936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 585.36, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 351.21, "standard_charge_percentage": 30.0000, "estimated_amount": 351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 229.23, "standard_charge_percentage": 19.5800, "estimated_amount": 229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 936.57, "standard_charge_percentage": 80.0000, "estimated_amount": 936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 973.19, "estimated_amount": 973, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 756.92, "estimated_amount": 756, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 218.34, "standard_charge_percentage": 18.6500, "estimated_amount": 218, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 222.7, "standard_charge_percentage": 19.0200, "estimated_amount": 222, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1009.23, "estimated_amount": 1009, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 917.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 917.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 576.7, "estimated_amount": 576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1153.41, "estimated_amount": 1153, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1059.33, "estimated_amount": 1059, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Intrmd Face <2.5 Cm", "code_information": [ { "code": "12051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1170.71, "discounted_cash": 611,"minimum": 218.34,"maximum": 13848,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 917.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 218.34, "standard_charge_percentage": 18.6500, "estimated_amount": 218, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 222.7, "standard_charge_percentage": 19.0200, "estimated_amount": 222, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 936.57, "standard_charge_percentage": 80.0000, "estimated_amount": 936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 229.23, "standard_charge_percentage": 19.5800, "estimated_amount": 229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 917.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3228.32, "standard_charge_percentage": 18.6500, "estimated_amount": 3228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5193, "standard_charge_percentage": 30.0000, "estimated_amount": 5193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 585.36, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 351.21, "standard_charge_percentage": 30.0000, "estimated_amount": 351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 936.57, "standard_charge_percentage": 80.0000, "estimated_amount": 936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8655, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3292.88, "standard_charge_percentage": 19.0200, "estimated_amount": 3292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3389.3, "standard_charge_percentage": 19.5800, "estimated_amount": 3389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Intrmd Face 2.6-5.0 Cm", "code_information": [ { "code": "12052", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1170.71, "discounted_cash": 611,"minimum": 218.34,"maximum": 1170.71,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 222.7, "standard_charge_percentage": 19.0200, "estimated_amount": 222, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 936.57, "standard_charge_percentage": 80.0000, "estimated_amount": 936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 585.36, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 917.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 218.34, "standard_charge_percentage": 18.6500, "estimated_amount": 218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 351.21, "standard_charge_percentage": 30.0000, "estimated_amount": 351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 917.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 229.23, "standard_charge_percentage": 19.5800, "estimated_amount": 229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 936.57, "standard_charge_percentage": 80.0000, "estimated_amount": 936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Intrmd Face 5.1-7.5 Cm", "code_information": [ { "code": "12053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1636.94, "discounted_cash": 611,"minimum": 305.29,"maximum": 1636.94,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 818.47, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 818, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 305.29, "standard_charge_percentage": 18.6500, "estimated_amount": 305, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 311.4, "standard_charge_percentage": 19.0200, "estimated_amount": 311, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 320.51, "standard_charge_percentage": 19.5800, "estimated_amount": 320, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1309.55, "standard_charge_percentage": 80.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 491.08, "standard_charge_percentage": 30.0000, "estimated_amount": 491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1309.55, "standard_charge_percentage": 80.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1283.36, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1283.36, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Intrmd Face 7.6-12.5 Cm", "code_information": [ { "code": "12054", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1636.94, "discounted_cash": 611,"minimum": 305.29,"maximum": 1636.94,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1283.36, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1283.36, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1283, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 311.4, "standard_charge_percentage": 19.0200, "estimated_amount": 311, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 818.47, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 818, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1309.55, "standard_charge_percentage": 80.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 305.29, "standard_charge_percentage": 18.6500, "estimated_amount": 305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1309.55, "standard_charge_percentage": 80.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 491.08, "standard_charge_percentage": 30.0000, "estimated_amount": 491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 320.51, "standard_charge_percentage": 19.5800, "estimated_amount": 320, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Intrmd Face 12.6-20 Cm", "code_information": [ { "code": "12055", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1170.71, "discounted_cash": 611,"minimum": 218.34,"maximum": 1170.71,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 585.36, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 917.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 917.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 218.34, "standard_charge_percentage": 18.6500, "estimated_amount": 218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 936.57, "standard_charge_percentage": 80.0000, "estimated_amount": 936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 229.23, "standard_charge_percentage": 19.5800, "estimated_amount": 229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 936.57, "standard_charge_percentage": 80.0000, "estimated_amount": 936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 222.7, "standard_charge_percentage": 19.0200, "estimated_amount": 222, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 351.21, "standard_charge_percentage": 30.0000, "estimated_amount": 351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Intrmd Face 20.1-30 Cm", "code_information": [ { "code": "12056", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1170.71, "discounted_cash": 611,"minimum": 218.34,"maximum": 1170.71,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 351.21, "standard_charge_percentage": 30.0000, "estimated_amount": 351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 229.23, "standard_charge_percentage": 19.5800, "estimated_amount": 229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 936.57, "standard_charge_percentage": 80.0000, "estimated_amount": 936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 917.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 917.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 222.7, "standard_charge_percentage": 19.0200, "estimated_amount": 222, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 936.57, "standard_charge_percentage": 80.0000, "estimated_amount": 936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 585.36, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 218.34, "standard_charge_percentage": 18.6500, "estimated_amount": 218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Intrmd Face >30.1 Cm", "code_information": [ { "code": "12057", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1170.71, "discounted_cash": 611,"minimum": 218.34,"maximum": 1170.71,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 351.21, "standard_charge_percentage": 30.0000, "estimated_amount": 351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 229.23, "standard_charge_percentage": 19.5800, "estimated_amount": 229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 917.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 218.34, "standard_charge_percentage": 18.6500, "estimated_amount": 218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 917.84, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 222.7, "standard_charge_percentage": 19.0200, "estimated_amount": 222, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 936.57, "standard_charge_percentage": 80.0000, "estimated_amount": 936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 585.36, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1170.71, "estimated_amount": 1170, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 936.57, "standard_charge_percentage": 80.0000, "estimated_amount": 936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Cplx Trunk 1.1-2.5 Cm", "code_information": [ { "code": "13100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2056.46, "discounted_cash": 937,"minimum": 383.53,"maximum": 13848,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2056.46, "estimated_amount": 2056, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2056.46, "estimated_amount": 2056, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1645.17, "standard_charge_percentage": 80.0000, "estimated_amount": 1645, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1009.23, "estimated_amount": 1009, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8655, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 576.7, "estimated_amount": 576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1009.23, "estimated_amount": 1009, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1612.26, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1612, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 383.53, "standard_charge_percentage": 18.6500, "estimated_amount": 383, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 391.2, "standard_charge_percentage": 19.0200, "estimated_amount": 391, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 973.19, "estimated_amount": 973, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1059.33, "estimated_amount": 1059, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 756.92, "estimated_amount": 756, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1028.23, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1028, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 616.94, "standard_charge_percentage": 30.0000, "estimated_amount": 616, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 576.7, "estimated_amount": 576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1153.41, "estimated_amount": 1153, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3389.3, "standard_charge_percentage": 19.5800, "estimated_amount": 3389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1612.26, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1612, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1645.17, "standard_charge_percentage": 80.0000, "estimated_amount": 1645, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 402.65, "standard_charge_percentage": 19.5800, "estimated_amount": 402, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3292.88, "standard_charge_percentage": 19.0200, "estimated_amount": 3292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5193, "standard_charge_percentage": 30.0000, "estimated_amount": 5193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 973.19, "estimated_amount": 973, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1153.41, "estimated_amount": 1153, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1059.33, "estimated_amount": 1059, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 756.92, "estimated_amount": 756, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3228.32, "standard_charge_percentage": 18.6500, "estimated_amount": 3228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Cplx Trnk 2.6-7.5 Cm", "code_information": [ { "code": "13101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1799.94, "discounted_cash": 937,"minimum": 335.69,"maximum": 1799.94,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1411.15, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 973.19, "estimated_amount": 973, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1059.33, "estimated_amount": 1059, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 756.92, "estimated_amount": 756, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1439.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1153.41, "estimated_amount": 1153, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1009.23, "estimated_amount": 1009, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 342.4, "standard_charge_percentage": 19.0200, "estimated_amount": 342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 539.98, "standard_charge_percentage": 30.0000, "estimated_amount": 539, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 352.43, "standard_charge_percentage": 19.5800, "estimated_amount": 352, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1799.94, "estimated_amount": 1799, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1799.94, "estimated_amount": 1799, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 899.97, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 899, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1799.94, "estimated_amount": 1799, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1411.15, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 335.69, "standard_charge_percentage": 18.6500, "estimated_amount": 335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1439.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 576.7, "estimated_amount": 576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "13102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3847.5,"minimum": 717.56,"maximum": 3078,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1923.75, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1923, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3078, "standard_charge_percentage": 80.0000, "estimated_amount": 3078, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 753.34, "standard_charge_percentage": 19.5800, "estimated_amount": 753, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3078, "standard_charge_percentage": 80.0000, "estimated_amount": 3078, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3016.44, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3016, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 717.56, "standard_charge_percentage": 18.6500, "estimated_amount": 717, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 731.91, "standard_charge_percentage": 19.0200, "estimated_amount": 731, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3016.44, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3016, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1154.25, "standard_charge_percentage": 30.0000, "estimated_amount": 1154, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Repr Wnd Cplx Scalp 1.1-2.5 Cm", "code_information": [ { "code": "13120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1799.94, "discounted_cash": 937,"minimum": 335.69,"maximum": 1799.94,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1799.94, "estimated_amount": 1799, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1411.15, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 539.98, "standard_charge_percentage": 30.0000, "estimated_amount": 539, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1439.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 756.92, "estimated_amount": 756, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1799.94, "estimated_amount": 1799, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 899.97, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 899, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1411.15, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 335.69, "standard_charge_percentage": 18.6500, "estimated_amount": 335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 576.7, "estimated_amount": 576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1009.23, "estimated_amount": 1009, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1799.94, "estimated_amount": 1799, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1439.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 342.4, "standard_charge_percentage": 19.0200, "estimated_amount": 342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 352.43, "standard_charge_percentage": 19.5800, "estimated_amount": 352, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 973.19, "estimated_amount": 973, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1153.41, "estimated_amount": 1153, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1059.33, "estimated_amount": 1059, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Cplx Scalp 2.6-7.5 Cm", "code_information": [ { "code": "13121", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2578.33, "discounted_cash": 937,"minimum": 480.86,"maximum": 2578.33,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2578.33, "estimated_amount": 2578, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2062.66, "standard_charge_percentage": 80.0000, "estimated_amount": 2062, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2062.66, "standard_charge_percentage": 80.0000, "estimated_amount": 2062, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 773.5, "standard_charge_percentage": 30.0000, "estimated_amount": 773, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 973.19, "estimated_amount": 973, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 756.92, "estimated_amount": 756, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 2021.41, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2021, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 2021.41, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2021, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 490.48, "standard_charge_percentage": 19.0200, "estimated_amount": 490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 504.84, "standard_charge_percentage": 19.5800, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 576.7, "estimated_amount": 576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1153.41, "estimated_amount": 1153, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1009.23, "estimated_amount": 1009, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1059.33, "estimated_amount": 1059, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1289.16, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1289, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 480.86, "standard_charge_percentage": 18.6500, "estimated_amount": 480, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Cplx Scalp Add 5.0 Cm", "code_information": [ { "code": "13122", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1312.5,"minimum": 244.78,"maximum": 1312.5,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1312.5, "estimated_amount": 1312, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1029, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1029, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1312.5, "estimated_amount": 1312, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 244.78, "standard_charge_percentage": 18.6500, "estimated_amount": 244, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1029, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1029, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 249.68, "standard_charge_percentage": 19.0200, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 393.75, "standard_charge_percentage": 30.0000, "estimated_amount": 393, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1050, "standard_charge_percentage": 80.0000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1312.5, "estimated_amount": 1312, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 656.25, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 656, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1312.5, "estimated_amount": 1312, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1050, "standard_charge_percentage": 80.0000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 256.99, "standard_charge_percentage": 19.5800, "estimated_amount": 256, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Repr Wnd Cplx Face/Hnd/Ft/Gent 1.1-2.5 Cm", "code_information": [ { "code": "13131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1636.94, "discounted_cash": 611,"minimum": 305.29,"maximum": 1636.94,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 818.47, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 818, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1283.36, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1283.36, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1309.55, "standard_charge_percentage": 80.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 311.4, "standard_charge_percentage": 19.0200, "estimated_amount": 311, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1309.55, "standard_charge_percentage": 80.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 305.29, "standard_charge_percentage": 18.6500, "estimated_amount": 305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 491.08, "standard_charge_percentage": 30.0000, "estimated_amount": 491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 320.51, "standard_charge_percentage": 19.5800, "estimated_amount": 320, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Cplx Face/Hnd/Ft/Gent 2.6-7.5 Cm", "code_information": [ { "code": "13132", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2578.33, "discounted_cash": 937,"minimum": 480.86,"maximum": 2578.33,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2578.33, "estimated_amount": 2578, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 2021.41, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2021, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2062.66, "standard_charge_percentage": 80.0000, "estimated_amount": 2062, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1153.41, "estimated_amount": 1153, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 2021.41, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2021, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 973.19, "estimated_amount": 973, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1059.33, "estimated_amount": 1059, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 756.92, "estimated_amount": 756, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1289.16, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1289, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 480.86, "standard_charge_percentage": 18.6500, "estimated_amount": 480, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 490.48, "standard_charge_percentage": 19.0200, "estimated_amount": 490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 773.5, "standard_charge_percentage": 30.0000, "estimated_amount": 773, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 504.84, "standard_charge_percentage": 19.5800, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2062.66, "standard_charge_percentage": 80.0000, "estimated_amount": 2062, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 576.7, "estimated_amount": 576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1009.23, "estimated_amount": 1009, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Cplx Face/Hnd/Ft/Gent Ea Add 5.0 Cm", "code_information": [ { "code": "13133", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1437,"minimum": 268,"maximum": 1437,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 718.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 718, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 268, "standard_charge_percentage": 18.6500, "estimated_amount": 268, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 273.36, "standard_charge_percentage": 19.0200, "estimated_amount": 273, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 431.1, "standard_charge_percentage": 30.0000, "estimated_amount": 431, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 281.36, "standard_charge_percentage": 19.5800, "estimated_amount": 281, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1149.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1149, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1126.61, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1126, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1437, "estimated_amount": 1437, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1437, "estimated_amount": 1437, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1437, "estimated_amount": 1437, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1437, "estimated_amount": 1437, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1126.61, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1126, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1149.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1149, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Repr Wnd Cplx Eye/Ear/Nose/Lip 1.1-2.5 Cm", "code_information": [ { "code": "13151", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1799.94, "discounted_cash": 937,"minimum": 335.69,"maximum": 1799.94,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1799.94, "estimated_amount": 1799, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1799.94, "estimated_amount": 1799, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1411.15, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 539.98, "standard_charge_percentage": 30.0000, "estimated_amount": 539, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 352.43, "standard_charge_percentage": 19.5800, "estimated_amount": 352, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1439.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 973.19, "estimated_amount": 973, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1059.33, "estimated_amount": 1059, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 899.97, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 899, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1411.15, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1153.41, "estimated_amount": 1153, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1799.94, "estimated_amount": 1799, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 335.69, "standard_charge_percentage": 18.6500, "estimated_amount": 335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1439.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 756.92, "estimated_amount": 756, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 342.4, "standard_charge_percentage": 19.0200, "estimated_amount": 342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 576.7, "estimated_amount": 576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1009.23, "estimated_amount": 1009, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Cplx Eye/Ear/Nose/Lip 2.6-7.5 Cm", "code_information": [ { "code": "13152", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1799.94, "discounted_cash": 937,"minimum": 335.69,"maximum": 1799.94,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 899.97, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 899, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1411.15, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 335.69, "standard_charge_percentage": 18.6500, "estimated_amount": 335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 973.19, "estimated_amount": 973, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1799.94, "estimated_amount": 1799, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1411.15, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 539.98, "standard_charge_percentage": 30.0000, "estimated_amount": 539, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1439.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1009.23, "estimated_amount": 1009, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 342.4, "standard_charge_percentage": 19.0200, "estimated_amount": 342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 352.43, "standard_charge_percentage": 19.5800, "estimated_amount": 352, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 756.92, "estimated_amount": 756, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1799.94, "estimated_amount": 1799, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1799.94, "estimated_amount": 1799, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1439.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 576.7, "estimated_amount": 576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1153.41, "estimated_amount": 1153, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1059.33, "estimated_amount": 1059, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Cplx Eye/Ear/Nose/Lip Ea Add 5.0 Cm", "code_information": [ { "code": "13153", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1506,"minimum": 280.87,"maximum": 1506,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1506, "estimated_amount": 1506, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 753, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 753, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1506, "estimated_amount": 1506, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 286.49, "standard_charge_percentage": 19.0200, "estimated_amount": 286, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 451.8, "standard_charge_percentage": 30.0000, "estimated_amount": 451, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1180.7, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 294.87, "standard_charge_percentage": 19.5800, "estimated_amount": 294, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1506, "estimated_amount": 1506, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1204.8, "standard_charge_percentage": 80.0000, "estimated_amount": 1204, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1204.8, "standard_charge_percentage": 80.0000, "estimated_amount": 1204, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1506, "estimated_amount": 1506, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1180.7, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 280.87, "standard_charge_percentage": 18.6500, "estimated_amount": 280, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Secondary Closure Surg Wound Dehiscense Complicated", "code_information": [ { "code": "13160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10687.5, "discounted_cash": 2800,"minimum": 1715,"maximum": 13848,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 9084.38, "standard_charge_percentage": 85.0000, "estimated_amount": 9084, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2908.18, "estimated_amount": 2908, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3015.89, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8655, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5193, "standard_charge_percentage": 30.0000, "estimated_amount": 5193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1723.37, "estimated_amount": 1723, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3446.74, "estimated_amount": 3446, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2261.92, "estimated_amount": 2261, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2033.08, "standard_charge_percentage": 19.0200, "estimated_amount": 2033, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3206.25, "standard_charge_percentage": 30.0000, "estimated_amount": 3206, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2092.61, "standard_charge_percentage": 19.5800, "estimated_amount": 2092, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1723.37, "estimated_amount": 1723, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3446.74, "estimated_amount": 3446, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2261.92, "estimated_amount": 2261, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5343.75, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5343, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1993.22, "standard_charge_percentage": 18.6500, "estimated_amount": 1993, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 9084.38, "standard_charge_percentage": 85.0000, "estimated_amount": 9084, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 8379, "standard_charge_percentage": 78.4000, "estimated_amount": 8379, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 8379, "standard_charge_percentage": 78.4000, "estimated_amount": 8379, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3165.61, "estimated_amount": 3165, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3389.3, "standard_charge_percentage": 19.5800, "estimated_amount": 3389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3292.88, "standard_charge_percentage": 19.0200, "estimated_amount": 3292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3228.32, "standard_charge_percentage": 18.6500, "estimated_amount": 3228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2908.18, "estimated_amount": 2908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3015.89, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3165.61, "estimated_amount": 3165, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "14020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5343.33, "discounted_cash": 2800,"minimum": 996.53,"maximum": 4566.93,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2671.66, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4189.17, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4189, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4274.66, "standard_charge_percentage": 80.0000, "estimated_amount": 4274, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1603, "standard_charge_percentage": 30.0000, "estimated_amount": 1603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2908.18, "estimated_amount": 2908, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4189.17, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4189, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1723.37, "estimated_amount": 1723, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3446.74, "estimated_amount": 3446, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2261.92, "estimated_amount": 2261, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 996.53, "standard_charge_percentage": 18.6500, "estimated_amount": 996, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1016.46, "standard_charge_percentage": 19.0200, "estimated_amount": 1016, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3015.89, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3165.61, "estimated_amount": 3165, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1046.22, "standard_charge_percentage": 19.5800, "estimated_amount": 1046, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4274.66, "standard_charge_percentage": 80.0000, "estimated_amount": 4274, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" }]}]} , { "description": "Hc Adjacent Tissue Trns/Reargmt F/C/C/M/N/A/G/H/F 10Sqcm/&Lt", "code_information": [ { "code": "14040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5040, "discounted_cash": 2800,"minimum": 939.96,"maximum": 31158,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2520, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2520, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 4284, "standard_charge_percentage": 85.0000, "estimated_amount": 4284, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1512, "standard_charge_percentage": 30.0000, "estimated_amount": 1512, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4032, "standard_charge_percentage": 80.0000, "estimated_amount": 4032, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1723.37, "estimated_amount": 1723, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 31158, "standard_charge_percentage": 80.0000, "estimated_amount": 31158, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 11684.3, "standard_charge_percentage": 30.0000, "estimated_amount": 11684, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1723.37, "estimated_amount": 1723, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3446.74, "estimated_amount": 3446, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 986.83, "standard_charge_percentage": 19.5800, "estimated_amount": 986, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 4284, "standard_charge_percentage": 85.0000, "estimated_amount": 4284, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 958.76, "standard_charge_percentage": 19.0200, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3951.36, "standard_charge_percentage": 78.4000, "estimated_amount": 3951, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2908.18, "estimated_amount": 2908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3446.74, "estimated_amount": 3446, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3015.89, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3165.61, "estimated_amount": 3165, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 939.96, "standard_charge_percentage": 18.6500, "estimated_amount": 939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4032, "standard_charge_percentage": 80.0000, "estimated_amount": 4032, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3951.36, "standard_charge_percentage": 78.4000, "estimated_amount": 3951, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2261.92, "estimated_amount": 2261, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2908.18, "estimated_amount": 2908, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 7408.98, "standard_charge_percentage": 19.0200, "estimated_amount": 7408, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 31158, "standard_charge_percentage": 80.0000, "estimated_amount": 31158, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2261.92, "estimated_amount": 2261, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 7263.71, "standard_charge_percentage": 18.6500, "estimated_amount": 7263, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 7625.92, "standard_charge_percentage": 19.5800, "estimated_amount": 7625, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3015.89, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3165.61, "estimated_amount": 3165, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" }]}]} , { "description": "Hc Prep Wnd Trk/Ar/Lg 100 Sqcm Or 1% Peds", "code_information": [ { "code": "15002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2402.4, "discounted_cash": 2800,"minimum": 448.05,"maximum": 2402.4,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1883.48, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1883, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 720.72, "standard_charge_percentage": 30.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 2402.4, "estimated_amount": 2402, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 2402.4, "estimated_amount": 2402, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1921.92, "standard_charge_percentage": 80.0000, "estimated_amount": 1921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1723.37, "estimated_amount": 1723, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 2402.4, "estimated_amount": 2402, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2261.92, "estimated_amount": 2261, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2402.4, "estimated_amount": 2402, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2402.4, "estimated_amount": 2402, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2402.4, "estimated_amount": 2402, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1883.48, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1883, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1921.92, "standard_charge_percentage": 80.0000, "estimated_amount": 1921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2402.4, "estimated_amount": 2402, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 2402.4, "estimated_amount": 2402, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2402.4, "estimated_amount": 2402, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 2402.4, "estimated_amount": 2402, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2402.4, "estimated_amount": 2402, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 2402.4, "estimated_amount": 2402, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1201.2, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1201, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 448.05, "standard_charge_percentage": 18.6500, "estimated_amount": 448, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 457.01, "standard_charge_percentage": 19.0200, "estimated_amount": 457, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 470.39, "standard_charge_percentage": 19.5800, "estimated_amount": 470, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 2402.4, "estimated_amount": 2402, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" }]}]} , { "description": "Hc Prep Wnd Head/Hnd/Ft/Gent 100 Sqcm Or 1% Peds", "code_information": [ { "code": "15004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2310.74, "discounted_cash": 937,"minimum": 430.95,"maximum": 2310.74,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 430.95, "standard_charge_percentage": 18.6500, "estimated_amount": 430, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 439.57, "standard_charge_percentage": 19.0200, "estimated_amount": 439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1848.59, "standard_charge_percentage": 80.0000, "estimated_amount": 1848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 693.22, "standard_charge_percentage": 30.0000, "estimated_amount": 693, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 576.7, "estimated_amount": 576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1009.23, "estimated_amount": 1009, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2310.74, "estimated_amount": 2310, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1811.62, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1811, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 973.19, "estimated_amount": 973, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1441.76, "estimated_amount": 1441, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1811.62, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1811, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 452.44, "standard_charge_percentage": 19.5800, "estimated_amount": 452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1848.59, "standard_charge_percentage": 80.0000, "estimated_amount": 1848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 756.92, "estimated_amount": 756, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1240.63, "estimated_amount": 1240, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1153.41, "estimated_amount": 1153, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 720.88, "estimated_amount": 720, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1059.33, "estimated_amount": 1059, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1528.27, "estimated_amount": 1528, "methodology": "fee schedule" }]}]} , { "description": "Skin splt grft trnkarmleg", "code_information": [ { "code": "15100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25965, "discounted_cash": 2800,"minimum": 1715,"maximum": 20772,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1723.37, "estimated_amount": 1723, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3446.74, "estimated_amount": 3446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3165.61, "estimated_amount": 3165, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2261.92, "estimated_amount": 2261, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4842.47, "standard_charge_percentage": 18.6500, "estimated_amount": 4842, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 20772, "standard_charge_percentage": 80.0000, "estimated_amount": 20772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5083.95, "standard_charge_percentage": 19.5800, "estimated_amount": 5083, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4939.32, "standard_charge_percentage": 19.0200, "estimated_amount": 4939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 20772, "standard_charge_percentage": 80.0000, "estimated_amount": 20772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7789.5, "standard_charge_percentage": 30.0000, "estimated_amount": 7789, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2908.18, "estimated_amount": 2908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3015.89, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" }]}]} , { "description": "Hc Epidrm Autogrft Trnk/Arm/Leg <100 Sqcm", "code_information": [ { "code": "15110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4743.2, "discounted_cash": 2800,"minimum": 884.61,"maximum": 4566.93,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1422.96, "standard_charge_percentage": 30.0000, "estimated_amount": 1422, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 928.72, "standard_charge_percentage": 19.5800, "estimated_amount": 928, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3794.56, "standard_charge_percentage": 80.0000, "estimated_amount": 3794, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3446.74, "estimated_amount": 3446, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3015.89, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2371.6, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2371, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3718.67, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3718, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1723.37, "estimated_amount": 1723, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2261.92, "estimated_amount": 2261, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3718.67, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3718, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 884.61, "standard_charge_percentage": 18.6500, "estimated_amount": 884, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 902.3, "standard_charge_percentage": 19.0200, "estimated_amount": 902, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3794.56, "standard_charge_percentage": 80.0000, "estimated_amount": 3794, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2908.18, "estimated_amount": 2908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3165.61, "estimated_amount": 3165, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" }]}]} , { "description": "INJ NEUROLYT; EPID LUMB/CAUDAL", "code_information": [ { "code": "15111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2630.25,"minimum": 490.54,"maximum": 2630.25,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1315.13, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1315, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 789.08, "standard_charge_percentage": 30.0000, "estimated_amount": 789, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 490.54, "standard_charge_percentage": 18.6500, "estimated_amount": 490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2104.2, "standard_charge_percentage": 80.0000, "estimated_amount": 2104, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2104.2, "standard_charge_percentage": 80.0000, "estimated_amount": 2104, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 2062.12, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2062, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 2062.12, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2062, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 500.35, "standard_charge_percentage": 19.0200, "estimated_amount": 500, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2630.25, "estimated_amount": 2630, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 515, "standard_charge_percentage": 19.5800, "estimated_amount": 515, "methodology": "percent of total billed charges" }]}]} , { "description": "PERCUTANEOUS DISKECTOMY", "code_information": [ { "code": "15115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4233, "discounted_cash": 2800,"minimum": 789.45,"maximum": 4233,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3318.67, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3318, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 789.45, "standard_charge_percentage": 18.6500, "estimated_amount": 789, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3386.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3386, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3386.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3386, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4233, "estimated_amount": 4233, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4233, "estimated_amount": 4233, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3165.61, "estimated_amount": 3165, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4233, "estimated_amount": 4233, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2908.18, "estimated_amount": 2908, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3015.89, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3318.67, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3318, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 805.24, "standard_charge_percentage": 19.0200, "estimated_amount": 805, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1269.9, "standard_charge_percentage": 30.0000, "estimated_amount": 1269, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 828.82, "standard_charge_percentage": 19.5800, "estimated_amount": 828, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1723.37, "estimated_amount": 1723, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2261.92, "estimated_amount": 2261, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4233, "estimated_amount": 4233, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2116.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3446.74, "estimated_amount": 3446, "methodology": "fee schedule" }]}]} , { "description": "INJECT INTO DISK LESION", "code_information": [ { "code": "15116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1501.19,"minimum": 279.97,"maximum": 1501.19,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 450.36, "standard_charge_percentage": 30.0000, "estimated_amount": 450, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 293.93, "standard_charge_percentage": 19.5800, "estimated_amount": 293, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1501.19, "estimated_amount": 1501, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1501.19, "estimated_amount": 1501, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1176.93, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1176, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 750.6, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 750, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1501.19, "estimated_amount": 1501, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1176.93, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1176, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 279.97, "standard_charge_percentage": 18.6500, "estimated_amount": 279, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 285.57, "standard_charge_percentage": 19.0200, "estimated_amount": 285, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1501.19, "estimated_amount": 1501, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1200.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1200, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1200.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1200, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "15120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8118.37, "discounted_cash": 5604,"minimum": 1514.08,"maximum": 8118.37,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1589.58, "standard_charge_percentage": 19.5800, "estimated_amount": 1589, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 7419.87, "estimated_amount": 7419, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8118.37, "estimated_amount": 8118, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4526.94, "estimated_amount": 4526, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8118.37, "estimated_amount": 8118, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1544.36, "standard_charge_percentage": 19.0200, "estimated_amount": 1544, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6494.7, "standard_charge_percentage": 80.0000, "estimated_amount": 6494, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6494.7, "standard_charge_percentage": 80.0000, "estimated_amount": 6494, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 7419.87, "estimated_amount": 7419, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 7419.87, "estimated_amount": 7419, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 8118.37, "estimated_amount": 8118, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6335.56, "estimated_amount": 6335, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4059.18, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4059, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1514.08, "standard_charge_percentage": 18.6500, "estimated_amount": 1514, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2435.51, "standard_charge_percentage": 30.0000, "estimated_amount": 2435, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3449.1, "estimated_amount": 3449, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6898.19, "estimated_amount": 6898, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 6035.92, "estimated_amount": 6035, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5820.35, "estimated_amount": 5820, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8118.37, "estimated_amount": 8118, "methodology": "fee schedule" }]}]} , { "description": "I&D COMPLEX WOUND INFEC POSTOP", "code_information": [ { "code": "15271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7486.49, "discounted_cash": 2800,"minimum": 1396.23,"maximum": 5989.19,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1424.15, "standard_charge_percentage": 19.0200, "estimated_amount": 1424, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5989.19, "standard_charge_percentage": 80.0000, "estimated_amount": 5989, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2245.95, "standard_charge_percentage": 30.0000, "estimated_amount": 2245, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1723.37, "estimated_amount": 1723, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3165.61, "estimated_amount": 3165, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2908.18, "estimated_amount": 2908, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3743.24, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3743, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1396.23, "standard_charge_percentage": 18.6500, "estimated_amount": 1396, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3015.89, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1465.85, "standard_charge_percentage": 19.5800, "estimated_amount": 1465, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5989.19, "standard_charge_percentage": 80.0000, "estimated_amount": 5989, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3446.74, "estimated_amount": 3446, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2261.92, "estimated_amount": 2261, "methodology": "fee schedule" }]}]} , { "description": "D-19 BIOPSY SKIN LESION", "code_information": [ { "code": "15272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2389,"minimum": 445.55,"maximum": 2389,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2389, "estimated_amount": 2389, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1872.98, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1872, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1872.98, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1872, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 716.7, "standard_charge_percentage": 30.0000, "estimated_amount": 716, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 467.77, "standard_charge_percentage": 19.5800, "estimated_amount": 467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1911.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1911, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 454.46, "standard_charge_percentage": 19.0200, "estimated_amount": 454, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1194.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1194, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 445.55, "standard_charge_percentage": 18.6500, "estimated_amount": 445, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1911.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1911, "methodology": "percent of total billed charges" }]}]} , { "description": "D-19 BX SKIN ADDL LESION", "code_information": [ { "code": "15273", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10687.5, "discounted_cash": 5604,"minimum": 1715,"maximum": 9140.1,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5343.75, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5343, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5820.35, "estimated_amount": 5820, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 7419.87, "estimated_amount": 7419, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8622.74, "estimated_amount": 8622, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4526.94, "estimated_amount": 4526, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1993.22, "standard_charge_percentage": 18.6500, "estimated_amount": 1993, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3449.1, "estimated_amount": 3449, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 7419.87, "estimated_amount": 7419, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6898.19, "estimated_amount": 6898, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 6035.92, "estimated_amount": 6035, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 8622.74, "estimated_amount": 8622, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6335.56, "estimated_amount": 6335, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2033.08, "standard_charge_percentage": 19.0200, "estimated_amount": 2033, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3206.25, "standard_charge_percentage": 30.0000, "estimated_amount": 3206, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2092.61, "standard_charge_percentage": 19.5800, "estimated_amount": 2092, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 9140.1, "estimated_amount": 9140, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 9140.1, "estimated_amount": 9140, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 7419.87, "estimated_amount": 7419, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" }]}]} , { "description": "LIGATURE HEMORRHOIDECTOMY", "code_information": [ { "code": "15274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1132.65,"minimum": 211.24,"maximum": 1132.65,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 888, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 888, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 211.24, "standard_charge_percentage": 18.6500, "estimated_amount": 211, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 906.12, "standard_charge_percentage": 80.0000, "estimated_amount": 906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 339.8, "standard_charge_percentage": 30.0000, "estimated_amount": 339, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 221.77, "standard_charge_percentage": 19.5800, "estimated_amount": 221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 906.12, "standard_charge_percentage": 80.0000, "estimated_amount": 906, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1132.65, "estimated_amount": 1132, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 566.33, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 566, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 888, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 888, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1132.65, "estimated_amount": 1132, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1132.65, "estimated_amount": 1132, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1132.65, "estimated_amount": 1132, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 215.46, "standard_charge_percentage": 19.0200, "estimated_amount": 215, "methodology": "percent of total billed charges" }]}]} , { "description": "BIOPSY, THYROID", "code_information": [ { "code": "15275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7486.49, "discounted_cash": 2800,"minimum": 1396.23,"maximum": 24234,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2908.18, "estimated_amount": 2908, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3015.89, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3165.61, "estimated_amount": 3165, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3743.24, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3743, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1396.23, "standard_charge_percentage": 18.6500, "estimated_amount": 1396, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1424.15, "standard_charge_percentage": 19.0200, "estimated_amount": 1424, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5989.19, "standard_charge_percentage": 80.0000, "estimated_amount": 5989, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3446.74, "estimated_amount": 3446, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5649.55, "standard_charge_percentage": 18.6500, "estimated_amount": 5649, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5762.54, "standard_charge_percentage": 19.0200, "estimated_amount": 5762, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5931.27, "standard_charge_percentage": 19.5800, "estimated_amount": 5931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 24234, "standard_charge_percentage": 80.0000, "estimated_amount": 24234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3446.74, "estimated_amount": 3446, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3015.89, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2245.95, "standard_charge_percentage": 30.0000, "estimated_amount": 2245, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1465.85, "standard_charge_percentage": 19.5800, "estimated_amount": 1465, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5989.19, "standard_charge_percentage": 80.0000, "estimated_amount": 5989, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1723.37, "estimated_amount": 1723, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2261.92, "estimated_amount": 2261, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 9087.75, "standard_charge_percentage": 30.0000, "estimated_amount": 9087, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1723.37, "estimated_amount": 1723, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2261.92, "estimated_amount": 2261, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 24234, "standard_charge_percentage": 80.0000, "estimated_amount": 24234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2908.18, "estimated_amount": 2908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3165.61, "estimated_amount": 3165, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" }]}]} , { "description": "ASPIRATE/INJECT THYROID CYST", "code_information": [ { "code": "15276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2196.5,"minimum": 409.65,"maximum": 2196.5,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 417.84, "standard_charge_percentage": 19.0200, "estimated_amount": 417, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 430.07, "standard_charge_percentage": 19.5800, "estimated_amount": 430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1098.25, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1098, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1722.06, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1722, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 658.95, "standard_charge_percentage": 30.0000, "estimated_amount": 658, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1757.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1757, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2196.5, "estimated_amount": 2196, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2196.5, "estimated_amount": 2196, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1722.06, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1722, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 409.65, "standard_charge_percentage": 18.6500, "estimated_amount": 409, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1757.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1757, "methodology": "percent of total billed charges" }]}]} , { "description": "ASPIRATION/INJECTION THYROID C", "code_information": [ { "code": "15277", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7486.49, "discounted_cash": 2800,"minimum": 1396.23,"maximum": 5989.19,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3743.24, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3743, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1424.15, "standard_charge_percentage": 19.0200, "estimated_amount": 1424, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5989.19, "standard_charge_percentage": 80.0000, "estimated_amount": 5989, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1465.85, "standard_charge_percentage": 19.5800, "estimated_amount": 1465, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1396.23, "standard_charge_percentage": 18.6500, "estimated_amount": 1396, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5989.19, "standard_charge_percentage": 80.0000, "estimated_amount": 5989, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3446.74, "estimated_amount": 3446, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3015.89, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2245.95, "standard_charge_percentage": 30.0000, "estimated_amount": 2245, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1723.37, "estimated_amount": 1723, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2261.92, "estimated_amount": 2261, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2908.18, "estimated_amount": 2908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3165.61, "estimated_amount": 3165, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" }]}]} , { "description": "NEEDLE BX MUSCLE/SOFT TISSUE", "code_information": [ { "code": "15278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1065.5,"minimum": 198.72,"maximum": 1065.5,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1065.5, "estimated_amount": 1065, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 835.35, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 835, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 319.65, "standard_charge_percentage": 30.0000, "estimated_amount": 319, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1065.5, "estimated_amount": 1065, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 532.75, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 532, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 202.69, "standard_charge_percentage": 19.0200, "estimated_amount": 202, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 852.4, "standard_charge_percentage": 80.0000, "estimated_amount": 852, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1065.5, "estimated_amount": 1065, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1065.5, "estimated_amount": 1065, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 835.35, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 835, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 198.72, "standard_charge_percentage": 18.6500, "estimated_amount": 198, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 208.62, "standard_charge_percentage": 19.5800, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 852.4, "standard_charge_percentage": 80.0000, "estimated_amount": 852, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "15736", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1559.4, "discounted_cash": 2800,"minimum": 290.83,"maximum": 1559.4,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1559.4, "estimated_amount": 1559, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1559.4, "estimated_amount": 1559, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 296.64, "standard_charge_percentage": 19.0200, "estimated_amount": 296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1247.52, "standard_charge_percentage": 80.0000, "estimated_amount": 1247, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1247.52, "standard_charge_percentage": 80.0000, "estimated_amount": 1247, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1559.4, "estimated_amount": 1559, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1559.4, "estimated_amount": 1559, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1559.4, "estimated_amount": 1559, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1559.4, "estimated_amount": 1559, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1559.4, "estimated_amount": 1559, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 290.83, "standard_charge_percentage": 18.6500, "estimated_amount": 290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1559.4, "estimated_amount": 1559, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1559.4, "estimated_amount": 1559, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1559.4, "estimated_amount": 1559, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1559.4, "estimated_amount": 1559, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1559.4, "estimated_amount": 1559, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1559.4, "estimated_amount": 1559, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1559.4, "estimated_amount": 1559, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1559.4, "estimated_amount": 1559, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1559.4, "estimated_amount": 1559, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1559.4, "estimated_amount": 1559, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1559.4, "estimated_amount": 1559, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 467.82, "standard_charge_percentage": 30.0000, "estimated_amount": 467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 305.33, "standard_charge_percentage": 19.5800, "estimated_amount": 305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1559.4, "estimated_amount": 1559, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1559.4, "estimated_amount": 1559, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1559.4, "estimated_amount": 1559, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1559.4, "estimated_amount": 1559, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1559.4, "estimated_amount": 1559, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 779.7, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 779, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1222.57, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1222, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1222.57, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1222, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1559.4, "estimated_amount": 1559, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1559.4, "estimated_amount": 1559, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1559.4, "estimated_amount": 1559, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1559.4, "estimated_amount": 1559, "methodology": "fee schedule" }]}]} , { "description": "Hc Musc Myocutaneous/Fasciocutaneous Flap Lxtr", "code_information": [ { "code": "15738", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17091.3, "discounted_cash": 5604,"minimum": 1715,"maximum": 13673,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5820.35, "estimated_amount": 5820, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 7419.87, "estimated_amount": 7419, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8622.74, "estimated_amount": 8622, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4526.94, "estimated_amount": 4526, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8545.65, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8545, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5127.39, "standard_charge_percentage": 30.0000, "estimated_amount": 5127, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3449.1, "estimated_amount": 3449, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 7419.87, "estimated_amount": 7419, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6898.19, "estimated_amount": 6898, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 6035.92, "estimated_amount": 6035, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 8622.74, "estimated_amount": 8622, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6335.56, "estimated_amount": 6335, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 9140.1, "estimated_amount": 9140, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3187.53, "standard_charge_percentage": 18.6500, "estimated_amount": 3187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3346.48, "standard_charge_percentage": 19.5800, "estimated_amount": 3346, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13673, "standard_charge_percentage": 80.0000, "estimated_amount": 13673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 7419.87, "estimated_amount": 7419, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3251.28, "standard_charge_percentage": 19.0200, "estimated_amount": 3251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13673, "standard_charge_percentage": 80.0000, "estimated_amount": 13673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 9140.1, "estimated_amount": 9140, "methodology": "fee schedule" }]}]} , { "description": "Hc Graft Composite W/Primary Closure Donor Area", "code_information": [ { "code": "15760", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5314.15, "discounted_cash": 2800,"minimum": 991.09,"maximum": 4566.93,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4166.29, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4166, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1010.91, "standard_charge_percentage": 19.0200, "estimated_amount": 1010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1040.51, "standard_charge_percentage": 19.5800, "estimated_amount": 1040, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2908.18, "estimated_amount": 2908, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4166.29, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4166, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1594.24, "standard_charge_percentage": 30.0000, "estimated_amount": 1594, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4251.32, "standard_charge_percentage": 80.0000, "estimated_amount": 4251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3446.74, "estimated_amount": 3446, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2657.07, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 991.09, "standard_charge_percentage": 18.6500, "estimated_amount": 991, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4251.32, "standard_charge_percentage": 80.0000, "estimated_amount": 4251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1723.37, "estimated_amount": 1723, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2261.92, "estimated_amount": 2261, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3015.89, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3165.61, "estimated_amount": 3165, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "15770", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38475, "discounted_cash": 5604,"minimum": 1715,"maximum": 30780,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 11542.5, "standard_charge_percentage": 30.0000, "estimated_amount": 11542, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 7419.87, "estimated_amount": 7419, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 7533.4, "standard_charge_percentage": 19.5800, "estimated_amount": 7533, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 9140.1, "estimated_amount": 9140, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 30780, "standard_charge_percentage": 80.0000, "estimated_amount": 30780, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5820.35, "estimated_amount": 5820, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4526.94, "estimated_amount": 4526, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 7175.59, "standard_charge_percentage": 18.6500, "estimated_amount": 7175, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 7319.1, "standard_charge_percentage": 19.0200, "estimated_amount": 7319, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 30780, "standard_charge_percentage": 80.0000, "estimated_amount": 30780, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3449.1, "estimated_amount": 3449, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 7419.87, "estimated_amount": 7419, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 7419.87, "estimated_amount": 7419, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6898.19, "estimated_amount": 6898, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 6035.92, "estimated_amount": 6035, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8622.74, "estimated_amount": 8622, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 8622.74, "estimated_amount": 8622, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6335.56, "estimated_amount": 6335, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 4311.37, "estimated_amount": 4311, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 9140.1, "estimated_amount": 9140, "methodology": "fee schedule" }]}]} , { "description": "Removal sutr/staple req anes", "code_information": [ { "code": "15851", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17310, "discounted_cash": 2800,"minimum": 1715,"maximum": 13848,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3389.3, "standard_charge_percentage": 19.5800, "estimated_amount": 3389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8655, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3446.74, "estimated_amount": 3446, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3015.89, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3292.88, "standard_charge_percentage": 19.0200, "estimated_amount": 3292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5193, "standard_charge_percentage": 30.0000, "estimated_amount": 5193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2908.18, "estimated_amount": 2908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3165.61, "estimated_amount": 3165, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3228.32, "standard_charge_percentage": 18.6500, "estimated_amount": 3228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1723.37, "estimated_amount": 1723, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2261.92, "estimated_amount": 2261, "methodology": "fee schedule" }]}]} , { "description": "Hc Exc Coccygeal Pr Ulc W/Coccygectomy W/Prim Sutr", "code_information": [ { "code": "15920", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 736.16, "discounted_cash": 4381,"minimum": 137.29,"maximum": 736.16,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 736.16, "estimated_amount": 736, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 736.16, "estimated_amount": 736, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 577.15, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 577, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 588.93, "standard_charge_percentage": 80.0000, "estimated_amount": 588, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 220.85, "standard_charge_percentage": 30.0000, "estimated_amount": 220, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 144.14, "standard_charge_percentage": 19.5800, "estimated_amount": 144, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 736.16, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 736.16, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 736.16, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 736.16, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 736.16, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 140.04, "standard_charge_percentage": 19.0200, "estimated_amount": 140, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 736.16, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 736.16, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 736.16, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 736.16, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 736.16, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 736.16, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 736.16, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 368.08, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 368, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 736.16, "estimated_amount": 736, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 137.29, "standard_charge_percentage": 18.6500, "estimated_amount": 137, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 736.16, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 736.16, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 736.16, "estimated_amount": 736, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 577.15, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 577, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 588.93, "standard_charge_percentage": 80.0000, "estimated_amount": 588, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 736.16, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 736.16, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 736.16, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 736.16, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 736.16, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 736.16, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 736.16, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 736.16, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 736.16, "estimated_amount": 736, "methodology": "fee schedule" }]}]} , { "description": "Hc Treat Burn 1St Degree, Initial", "code_information": [ { "code": "16000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 821.86, "discounted_cash": 304,"minimum": 153.28,"maximum": 821.86,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 657.49, "standard_charge_percentage": 80.0000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 374.4, "estimated_amount": 374, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 644.34, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 644.34, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 315.9, "estimated_amount": 315, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 187.2, "estimated_amount": 187, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 410.93, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 410, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 245.7, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 153.28, "standard_charge_percentage": 18.6500, "estimated_amount": 153, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 156.34, "standard_charge_percentage": 19.0200, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 657.49, "standard_charge_percentage": 80.0000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 246.56, "standard_charge_percentage": 30.0000, "estimated_amount": 246, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 160.92, "standard_charge_percentage": 19.5800, "estimated_amount": 160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 343.86, "estimated_amount": 343, "methodology": "fee schedule" }]}]} , { "description": "Hc Dress/Debride Burn <5% Total Sm", "code_information": [ { "code": "16020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 821.86, "discounted_cash": 304,"minimum": 153.28,"maximum": 821.86,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 644.34, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 657.49, "standard_charge_percentage": 80.0000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 160.92, "standard_charge_percentage": 19.5800, "estimated_amount": 160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 374.4, "estimated_amount": 374, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 246.56, "standard_charge_percentage": 30.0000, "estimated_amount": 246, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 315.9, "estimated_amount": 315, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 187.2, "estimated_amount": 187, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 410.93, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 410, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 644.34, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 343.86, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 153.28, "standard_charge_percentage": 18.6500, "estimated_amount": 153, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 156.34, "standard_charge_percentage": 19.0200, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 657.49, "standard_charge_percentage": 80.0000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 245.7, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" }]}]} , { "description": "Hc Dress/Debride Burn 5-10% Ttl Med", "code_information": [ { "code": "16025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 821.86, "discounted_cash": 304,"minimum": 153.28,"maximum": 821.86,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 153.28, "standard_charge_percentage": 18.6500, "estimated_amount": 153, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 246.56, "standard_charge_percentage": 30.0000, "estimated_amount": 246, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 374.4, "estimated_amount": 374, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 410.93, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 410, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 657.49, "standard_charge_percentage": 80.0000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 160.92, "standard_charge_percentage": 19.5800, "estimated_amount": 160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 315.9, "estimated_amount": 315, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 187.2, "estimated_amount": 187, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 245.7, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 644.34, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 644, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 156.34, "standard_charge_percentage": 19.0200, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 657.49, "standard_charge_percentage": 80.0000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 343.86, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 644.34, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" }]}]} , { "description": "Hc Dress/Debride Burn >10% Ttl Lg", "code_information": [ { "code": "16030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 594, "discounted_cash": 611,"minimum": 110.78,"maximum": 594,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 594, "estimated_amount": 594, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 465.7, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 465, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 475.2, "standard_charge_percentage": 80.0000, "estimated_amount": 475, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 594, "estimated_amount": 594, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 594, "estimated_amount": 594, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 594, "estimated_amount": 594, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 594, "estimated_amount": 594, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 116.31, "standard_charge_percentage": 19.5800, "estimated_amount": 116, "methodology": "percent of total billed charges" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 594, "estimated_amount": 594, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 594, "estimated_amount": 594, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 465.7, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 465, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 178.2, "standard_charge_percentage": 30.0000, "estimated_amount": 178, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 475.2, "standard_charge_percentage": 80.0000, "estimated_amount": 475, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 594, "estimated_amount": 594, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 594, "estimated_amount": 594, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 594, "estimated_amount": 594, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 594, "estimated_amount": 594, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 297, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 297, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 110.78, "standard_charge_percentage": 18.6500, "estimated_amount": 110, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 113, "standard_charge_percentage": 19.0200, "estimated_amount": 113, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 594, "estimated_amount": 594, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 594, "estimated_amount": 594, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 594, "estimated_amount": 594, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 594, "estimated_amount": 594, "methodology": "fee schedule" }]}]} , { "description": "Hc Escharotomy", "code_information": [ { "code": "16035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1636.94, "discounted_cash": 611,"minimum": 305.29,"maximum": 1636.94,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1309.55, "standard_charge_percentage": 80.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 818.47, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 818, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1283.36, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1283.36, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 320.51, "standard_charge_percentage": 19.5800, "estimated_amount": 320, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 376.41, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1636.94, "estimated_amount": 1636, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 311.4, "standard_charge_percentage": 19.0200, "estimated_amount": 311, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1309.55, "standard_charge_percentage": 80.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 809.75, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 752.82, "estimated_amount": 752, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 494.04, "estimated_amount": 494, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 305.29, "standard_charge_percentage": 18.6500, "estimated_amount": 305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 491.08, "standard_charge_percentage": 30.0000, "estimated_amount": 491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 635.19, "estimated_amount": 635, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 941.02, "estimated_amount": 941, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 691.41, "estimated_amount": 691, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 470.51, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 997.48, "estimated_amount": 997, "methodology": "fee schedule" }]}]} , { "description": "Hc Destruc Benign/Premal,First Lesion", "code_information": [ { "code": "17000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 212.96, "discounted_cash": 304,"minimum": 39.72,"maximum": 212.96,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 212.96, "estimated_amount": 212, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 63.89, "standard_charge_percentage": 30.0000, "estimated_amount": 63, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 212.96, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 212.96, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 212.96, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 212.96, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 212.96, "estimated_amount": 212, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 170.37, "standard_charge_percentage": 80.0000, "estimated_amount": 170, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 41.7, "standard_charge_percentage": 19.5800, "estimated_amount": 41, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 212.96, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 212.96, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 212.96, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 212.96, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 212.96, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 212.96, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 212.96, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 166.96, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 166, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 212.96, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 187.2, "estimated_amount": 187, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 212.96, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 212.96, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 212.96, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 212.96, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 212.96, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 106.48, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 106, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 212.96, "estimated_amount": 212, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 212.96, "estimated_amount": 212, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 166.96, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 166, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 39.72, "standard_charge_percentage": 18.6500, "estimated_amount": 39, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 40.51, "standard_charge_percentage": 19.0200, "estimated_amount": 40, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 170.37, "standard_charge_percentage": 80.0000, "estimated_amount": 170, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 212.96, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 212.96, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 212.96, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 212.96, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 212.96, "estimated_amount": 212, "methodology": "fee schedule" }]}]} , { "description": "Hc Destruc Benign/Premal,2-14 Lesions", "code_information": [ { "code": "17003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 108,"minimum": 20.14,"maximum": 108,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 32.4, "standard_charge_percentage": 30.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 20.14, "standard_charge_percentage": 18.6500, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 84.67, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 84, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 20.54, "standard_charge_percentage": 19.0200, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 86.4, "standard_charge_percentage": 80.0000, "estimated_amount": 86, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 86.4, "standard_charge_percentage": 80.0000, "estimated_amount": 86, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 54, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 54, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 84.67, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 84, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 21.15, "standard_charge_percentage": 19.5800, "estimated_amount": 21, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Destruc Benign/Premal,15+ Lesions", "code_information": [ { "code": "17004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 108, "discounted_cash": 611,"minimum": 20.14,"maximum": 108,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 20.54, "standard_charge_percentage": 19.0200, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 54, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 54, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 84.67, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 84, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 86.4, "standard_charge_percentage": 80.0000, "estimated_amount": 86, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 20.14, "standard_charge_percentage": 18.6500, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 86.4, "standard_charge_percentage": 80.0000, "estimated_amount": 86, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 32.4, "standard_charge_percentage": 30.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 84.67, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 84, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 21.15, "standard_charge_percentage": 19.5800, "estimated_amount": 21, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "fee schedule" }]}]} , { "description": "Hc Chem Cautery Granulatn Tissue", "code_information": [ { "code": "17250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 821.86, "discounted_cash": 304,"minimum": 153.28,"maximum": 821.86,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 156.34, "standard_charge_percentage": 19.0200, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 657.49, "standard_charge_percentage": 80.0000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 187.2, "estimated_amount": 187, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 343.86, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 644.34, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 644.34, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 410.93, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 410, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 821.86, "estimated_amount": 821, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 374.4, "estimated_amount": 374, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 153.28, "standard_charge_percentage": 18.6500, "estimated_amount": 153, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 657.49, "standard_charge_percentage": 80.0000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 246.56, "standard_charge_percentage": 30.0000, "estimated_amount": 246, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 160.92, "standard_charge_percentage": 19.5800, "estimated_amount": 160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 315.9, "estimated_amount": 315, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 245.7, "estimated_amount": 245, "methodology": "fee schedule" }]}]} , { "description": "Hc I&D Breast Lesion", "code_information": [ { "code": "19000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2896.7, "discounted_cash": 1077,"minimum": 540.23,"maximum": 2896.7,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 2271.01, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2271, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 567.17, "standard_charge_percentage": 19.5800, "estimated_amount": 567, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2896.7, "estimated_amount": 2896, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1448.35, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1448, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 2271.01, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2271, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 540.23, "standard_charge_percentage": 18.6500, "estimated_amount": 540, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 551.04, "standard_charge_percentage": 19.0200, "estimated_amount": 551, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 869.01, "standard_charge_percentage": 30.0000, "estimated_amount": 869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" }]}]} , { "description": "Hc I&D Breast Lesion Add On", "code_information": [ { "code": "19001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 806,"minimum": 150.32,"maximum": 806,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 806, "estimated_amount": 806, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 806, "estimated_amount": 806, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 631.9, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 631, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 631.9, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 631, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 150.32, "standard_charge_percentage": 18.6500, "estimated_amount": 150, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 157.81, "standard_charge_percentage": 19.5800, "estimated_amount": 157, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 806, "estimated_amount": 806, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 403, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 403, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 806, "estimated_amount": 806, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 153.33, "standard_charge_percentage": 19.0200, "estimated_amount": 153, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 241.8, "standard_charge_percentage": 30.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 644.8, "standard_charge_percentage": 80.0000, "estimated_amount": 644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 644.8, "standard_charge_percentage": 80.0000, "estimated_amount": 644, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Mastotomy W Explor/Drain Absc, Deep", "code_information": [ { "code": "19020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5127.07, "discounted_cash": 2480,"minimum": 956.2,"maximum": 4415,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 956.2, "standard_charge_percentage": 18.6500, "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2563.53, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2563, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4019.62, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4019, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 975.32, "standard_charge_percentage": 19.0200, "estimated_amount": 975, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1538.12, "standard_charge_percentage": 30.0000, "estimated_amount": 1538, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4101.66, "standard_charge_percentage": 80.0000, "estimated_amount": 4101, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4019.62, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4019, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4101.66, "standard_charge_percentage": 80.0000, "estimated_amount": 4101, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1003.88, "standard_charge_percentage": 19.5800, "estimated_amount": 1003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "Hc Bx Breast W Device Stereotact Guide 1St Lesion", "code_information": [ { "code": "19081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6877.5, "discounted_cash": 2480,"minimum": 1282.65,"maximum": 5845.88,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 5845.88, "standard_charge_percentage": 85.0000, "estimated_amount": 5845, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1308.31, "standard_charge_percentage": 19.0200, "estimated_amount": 1308, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5391.96, "standard_charge_percentage": 78.4000, "estimated_amount": 5391, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 5845.88, "standard_charge_percentage": 85.0000, "estimated_amount": 5845, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3438.75, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3438, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5502, "standard_charge_percentage": 80.0000, "estimated_amount": 5502, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1282.65, "standard_charge_percentage": 18.6500, "estimated_amount": 1282, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5502, "standard_charge_percentage": 80.0000, "estimated_amount": 5502, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2063.25, "standard_charge_percentage": 30.0000, "estimated_amount": 2063, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1346.61, "standard_charge_percentage": 19.5800, "estimated_amount": 1346, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5391.96, "standard_charge_percentage": 78.4000, "estimated_amount": 5391, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" }]}]} , { "description": "Hc Bx Breast W Device Stereotact Guide Addl Lesion", "code_information": [ { "code": "19082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4821.48,"minimum": 899.21,"maximum": 4098.26,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 899.21, "standard_charge_percentage": 18.6500, "estimated_amount": 899, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 944.05, "standard_charge_percentage": 19.5800, "estimated_amount": 944, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2410.74, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2410, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 917.19, "standard_charge_percentage": 19.0200, "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1446.44, "standard_charge_percentage": 30.0000, "estimated_amount": 1446, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3780.04, "standard_charge_percentage": 78.4000, "estimated_amount": 3780, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 4098.26, "standard_charge_percentage": 85.0000, "estimated_amount": 4098, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 4098.26, "standard_charge_percentage": 85.0000, "estimated_amount": 4098, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3857.18, "standard_charge_percentage": 80.0000, "estimated_amount": 3857, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3780.04, "standard_charge_percentage": 78.4000, "estimated_amount": 3780, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3857.18, "standard_charge_percentage": 80.0000, "estimated_amount": 3857, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Bx Breast W Device Us Guide 1St Lesion", "code_information": [ { "code": "19083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6655.86, "discounted_cash": 2480,"minimum": 1241.32,"maximum": 5324.69,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5324.69, "standard_charge_percentage": 80.0000, "estimated_amount": 5324, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1303.22, "standard_charge_percentage": 19.5800, "estimated_amount": 1303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1241.32, "standard_charge_percentage": 18.6500, "estimated_amount": 1241, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1266.14, "standard_charge_percentage": 19.0200, "estimated_amount": 1266, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1996.76, "standard_charge_percentage": 30.0000, "estimated_amount": 1996, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3327.93, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3327, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5324.69, "standard_charge_percentage": 80.0000, "estimated_amount": 5324, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "US TESTICLE SONO", "code_information": [ { "code": "19084", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1405,"minimum": 262.03,"maximum": 1405,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1405, "estimated_amount": 1405, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1405, "estimated_amount": 1405, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1194.25, "standard_charge_percentage": 85.0000, "estimated_amount": 1194, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 275.1, "standard_charge_percentage": 19.5800, "estimated_amount": 275, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 262.03, "standard_charge_percentage": 18.6500, "estimated_amount": 262, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1194.25, "standard_charge_percentage": 85.0000, "estimated_amount": 1194, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1124, "standard_charge_percentage": 80.0000, "estimated_amount": 1124, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 421.5, "standard_charge_percentage": 30.0000, "estimated_amount": 421, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1101.52, "standard_charge_percentage": 78.4000, "estimated_amount": 1101, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1124, "standard_charge_percentage": 80.0000, "estimated_amount": 1124, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 702.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 702, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 267.27, "standard_charge_percentage": 19.0200, "estimated_amount": 267, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1101.52, "standard_charge_percentage": 78.4000, "estimated_amount": 1101, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Bx Breast W Device Mri Guide 1St Lesion", "code_information": [ { "code": "19085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 806.42, "discounted_cash": 2480,"minimum": 150.4,"maximum": 806.42,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 150.4, "standard_charge_percentage": 18.6500, "estimated_amount": 150, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 157.9, "standard_charge_percentage": 19.5800, "estimated_amount": 157, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 632.23, "standard_charge_percentage": 78.4000, "estimated_amount": 632, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 806.42, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 806.42, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 806.42, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 806.42, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 806.42, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 806.42, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 806.42, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 806.42, "estimated_amount": 806, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 403.21, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 403, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 685.46, "standard_charge_percentage": 85.0000, "estimated_amount": 685, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 153.41, "standard_charge_percentage": 19.0200, "estimated_amount": 153, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 241.93, "standard_charge_percentage": 30.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 645.14, "standard_charge_percentage": 80.0000, "estimated_amount": 645, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 806.42, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 806.42, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 806.42, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 806.42, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 685.46, "standard_charge_percentage": 85.0000, "estimated_amount": 685, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 645.14, "standard_charge_percentage": 80.0000, "estimated_amount": 645, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 806.42, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 806.42, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 806.42, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 806.42, "estimated_amount": 806, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 632.23, "standard_charge_percentage": 78.4000, "estimated_amount": 632, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 806.42, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 806.42, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 806.42, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 806.42, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 806.42, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 806.42, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 806.42, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 806.42, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 806.42, "estimated_amount": 806, "methodology": "fee schedule" }]}]} , { "description": "Hc Bx Breast W Device Mri Guide Addl Lesion", "code_information": [ { "code": "19086", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100,"minimum": 18.65,"maximum": 100,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 50, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 50, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 18.65, "standard_charge_percentage": 18.6500, "estimated_amount": 18, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 85, "standard_charge_percentage": 85.0000, "estimated_amount": 85, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 19.02, "standard_charge_percentage": 19.0200, "estimated_amount": 19, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 78.4, "standard_charge_percentage": 78.4000, "estimated_amount": 78, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 80, "standard_charge_percentage": 80.0000, "estimated_amount": 80, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 80, "standard_charge_percentage": 80.0000, "estimated_amount": 80, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 30, "standard_charge_percentage": 30.0000, "estimated_amount": 30, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 19.58, "standard_charge_percentage": 19.5800, "estimated_amount": 19, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 100, "estimated_amount": 100, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 100, "estimated_amount": 100, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 85, "standard_charge_percentage": 85.0000, "estimated_amount": 85, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 78.4, "standard_charge_percentage": 78.4000, "estimated_amount": 78, "methodology": "percent of total billed charges" }]}]} , { "description": "Removal of breast lesion", "code_information": [ { "code": "19120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22975.7, "discounted_cash": 5862,"minimum": 1715,"maximum": 18380.6,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6892.71, "standard_charge_percentage": 30.0000, "estimated_amount": 6892, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4498.64, "standard_charge_percentage": 19.5800, "estimated_amount": 4498, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 7760.99, "estimated_amount": 7760, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 7760.99, "estimated_amount": 7760, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 9019.16, "estimated_amount": 9019, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 9019.16, "estimated_amount": 9019, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4284.97, "standard_charge_percentage": 18.6500, "estimated_amount": 4284, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 7760.99, "estimated_amount": 7760, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 9560.31, "estimated_amount": 9560, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4370.67, "standard_charge_percentage": 19.0200, "estimated_amount": 4370, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 18380.6, "standard_charge_percentage": 80.0000, "estimated_amount": 18380, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 6087.93, "estimated_amount": 6087, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 7215.33, "estimated_amount": 7215, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 6313.41, "estimated_amount": 6313, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4735.06, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 18380.6, "standard_charge_percentage": 80.0000, "estimated_amount": 18380, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3607.66, "estimated_amount": 3607, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6626.83, "estimated_amount": 6626, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 9560.31, "estimated_amount": 9560, "methodology": "fee schedule" }]}]} , { "description": "Excision breast lesion", "code_information": [ { "code": "19125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32889, "discounted_cash": 5862,"minimum": 1715,"maximum": 26311.2,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 6256.47, "standard_charge_percentage": 19.0200, "estimated_amount": 6256, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 6087.93, "estimated_amount": 6087, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 7760.99, "estimated_amount": 7760, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 7760.99, "estimated_amount": 7760, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 9019.16, "estimated_amount": 9019, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6626.83, "estimated_amount": 6626, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 6133.8, "standard_charge_percentage": 18.6500, "estimated_amount": 6133, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 26311.2, "standard_charge_percentage": 80.0000, "estimated_amount": 26311, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 7215.33, "estimated_amount": 7215, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 6313.41, "estimated_amount": 6313, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4735.06, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 7760.99, "estimated_amount": 7760, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 9019.16, "estimated_amount": 9019, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 9866.7, "standard_charge_percentage": 30.0000, "estimated_amount": 9866, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 6439.67, "standard_charge_percentage": 19.5800, "estimated_amount": 6439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 26311.2, "standard_charge_percentage": 80.0000, "estimated_amount": 26311, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3607.66, "estimated_amount": 3607, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 9560.31, "estimated_amount": 9560, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 9560.31, "estimated_amount": 9560, "methodology": "fee schedule" }]}]} , { "description": "Hc Perq Dev Place Breast Loc 1St Les W Mammo Guid", "code_information": [ { "code": "19281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6655.86, "discounted_cash": 2480,"minimum": 1241.32,"maximum": 5657.48,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 5657.48, "standard_charge_percentage": 85.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5324.69, "standard_charge_percentage": 80.0000, "estimated_amount": 5324, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1996.76, "standard_charge_percentage": 30.0000, "estimated_amount": 1996, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1303.22, "standard_charge_percentage": 19.5800, "estimated_amount": 1303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5218.19, "standard_charge_percentage": 78.4000, "estimated_amount": 5218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1241.32, "standard_charge_percentage": 18.6500, "estimated_amount": 1241, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1266.14, "standard_charge_percentage": 19.0200, "estimated_amount": 1266, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3327.93, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3327, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 5657.48, "standard_charge_percentage": 85.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5218.19, "standard_charge_percentage": 78.4000, "estimated_amount": 5218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5324.69, "standard_charge_percentage": 80.0000, "estimated_amount": 5324, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "Hc Perq Device Placemt Breast Loc Ea Les W Guidnce", "code_information": [ { "code": "19282", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200,"minimum": 37.3,"maximum": 200,"payers_information":[{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 160, "standard_charge_percentage": 80.0000, "estimated_amount": 160, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 200, "estimated_amount": 200, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 100, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 100, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 156.8, "standard_charge_percentage": 78.4000, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 37.3, "standard_charge_percentage": 18.6500, "estimated_amount": 37, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 170, "standard_charge_percentage": 85.0000, "estimated_amount": 170, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 170, "standard_charge_percentage": 85.0000, "estimated_amount": 170, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 160, "standard_charge_percentage": 80.0000, "estimated_amount": 160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 60, "standard_charge_percentage": 30.0000, "estimated_amount": 60, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 39.16, "standard_charge_percentage": 19.5800, "estimated_amount": 39, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 200, "estimated_amount": 200, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 38.05, "standard_charge_percentage": 19.0200, "estimated_amount": 38, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 156.8, "standard_charge_percentage": 78.4000, "estimated_amount": 156, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Perq Breast Loc Dev Place Strotact Guid 1St Les", "code_information": [ { "code": "19283", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2403.2, "discounted_cash": 1077,"minimum": 448.2,"maximum": 2403.2,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 448.2, "standard_charge_percentage": 18.6500, "estimated_amount": 448, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 457.16, "standard_charge_percentage": 19.0200, "estimated_amount": 457, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 720.96, "standard_charge_percentage": 30.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1884.11, "standard_charge_percentage": 78.4000, "estimated_amount": 1884, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2403.2, "estimated_amount": 2403, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1201.6, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1201, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 2042.72, "standard_charge_percentage": 85.0000, "estimated_amount": 2042, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 470.55, "standard_charge_percentage": 19.5800, "estimated_amount": 470, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1884.11, "standard_charge_percentage": 78.4000, "estimated_amount": 1884, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 2042.72, "standard_charge_percentage": 85.0000, "estimated_amount": 2042, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" }]}]} , { "description": "Hc Perq Breast Loc Dev Place Strotact Guid Add Les", "code_information": [ { "code": "19284", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200,"minimum": 37.3,"maximum": 200,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 200, "estimated_amount": 200, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 100, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 100, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 156.8, "standard_charge_percentage": 78.4000, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 170, "standard_charge_percentage": 85.0000, "estimated_amount": 170, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 60, "standard_charge_percentage": 30.0000, "estimated_amount": 60, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 160, "standard_charge_percentage": 80.0000, "estimated_amount": 160, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 200, "estimated_amount": 200, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 38.05, "standard_charge_percentage": 19.0200, "estimated_amount": 38, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 156.8, "standard_charge_percentage": 78.4000, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 37.3, "standard_charge_percentage": 18.6500, "estimated_amount": 37, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 170, "standard_charge_percentage": 85.0000, "estimated_amount": 170, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 160, "standard_charge_percentage": 80.0000, "estimated_amount": 160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 39.16, "standard_charge_percentage": 19.5800, "estimated_amount": 39, "methodology": "percent of total billed charges" }]}]} , { "description": "US XTR NON VAS COMPLETE", "code_information": [ { "code": "19285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2896.7, "discounted_cash": 1077,"minimum": 540.23,"maximum": 2896.7,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2896.7, "estimated_amount": 2896, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 2462.19, "standard_charge_percentage": 85.0000, "estimated_amount": 2462, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 869.01, "standard_charge_percentage": 30.0000, "estimated_amount": 869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 567.17, "standard_charge_percentage": 19.5800, "estimated_amount": 567, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1448.35, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1448, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 540.23, "standard_charge_percentage": 18.6500, "estimated_amount": 540, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 551.04, "standard_charge_percentage": 19.0200, "estimated_amount": 551, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 2271.01, "standard_charge_percentage": 78.4000, "estimated_amount": 2271, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 2462.19, "standard_charge_percentage": 85.0000, "estimated_amount": 2462, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 2271.01, "standard_charge_percentage": 78.4000, "estimated_amount": 2271, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" }]}]} , { "description": "US XTR NON VASC LMTD", "code_information": [ { "code": "19286", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1119.76,"minimum": 208.84,"maximum": 1119.76,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 213.01, "standard_charge_percentage": 19.0200, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1119.76, "estimated_amount": 1119, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1119.76, "estimated_amount": 1119, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 208.84, "standard_charge_percentage": 18.6500, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 895.81, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 877.89, "standard_charge_percentage": 78.4000, "estimated_amount": 877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 877.89, "standard_charge_percentage": 78.4000, "estimated_amount": 877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 559.88, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 559, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 951.8, "standard_charge_percentage": 85.0000, "estimated_amount": 951, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 335.93, "standard_charge_percentage": 30.0000, "estimated_amount": 335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 895.81, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 951.8, "standard_charge_percentage": 85.0000, "estimated_amount": 951, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 219.25, "standard_charge_percentage": 19.5800, "estimated_amount": 219, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Perq Breast Loc Dev Place Mri Guide 1St Lesion", "code_information": [ { "code": "19287", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 112.85, "discounted_cash": 1077,"minimum": 21.05,"maximum": 112.85,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 56.42, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 56, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 95.92, "standard_charge_percentage": 85.0000, "estimated_amount": 95, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 88.47, "standard_charge_percentage": 78.4000, "estimated_amount": 88, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 112.85, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 112.85, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 112.85, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 112.85, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 112.85, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 112.85, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 112.85, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 112.85, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 112.85, "estimated_amount": 112, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 90.28, "standard_charge_percentage": 80.0000, "estimated_amount": 90, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 33.85, "standard_charge_percentage": 30.0000, "estimated_amount": 33, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 88.47, "standard_charge_percentage": 78.4000, "estimated_amount": 88, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 90.28, "standard_charge_percentage": 80.0000, "estimated_amount": 90, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 112.85, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 112.85, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 112.85, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 112.85, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 21.47, "standard_charge_percentage": 19.0200, "estimated_amount": 21, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 22.1, "standard_charge_percentage": 19.5800, "estimated_amount": 22, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 112.85, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 112.85, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 112.85, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 112.85, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 112.85, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 112.85, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 112.85, "estimated_amount": 112, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 21.05, "standard_charge_percentage": 18.6500, "estimated_amount": 21, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 95.92, "standard_charge_percentage": 85.0000, "estimated_amount": 95, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 112.85, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 112.85, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 112.85, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 112.85, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 112.85, "estimated_amount": 112, "methodology": "fee schedule" }]}]} , { "description": "Hc Perq Breast Loc Dev Place Mri Guide Addl Lesion", "code_information": [ { "code": "19288", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50,"minimum": 9.32,"maximum": 50,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 50, "estimated_amount": 50, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 50, "estimated_amount": 50, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 25, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 25, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 9.32, "standard_charge_percentage": 18.6500, "estimated_amount": 9, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 42.5, "standard_charge_percentage": 85.0000, "estimated_amount": 42, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 40, "standard_charge_percentage": 80.0000, "estimated_amount": 40, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 15, "standard_charge_percentage": 30.0000, "estimated_amount": 15, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 42.5, "standard_charge_percentage": 85.0000, "estimated_amount": 42, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 9.51, "standard_charge_percentage": 19.0200, "estimated_amount": 9, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 9.79, "standard_charge_percentage": 19.5800, "estimated_amount": 9, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 39.2, "standard_charge_percentage": 78.4000, "estimated_amount": 39, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 39.2, "standard_charge_percentage": 78.4000, "estimated_amount": 39, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 40, "standard_charge_percentage": 80.0000, "estimated_amount": 40, "methodology": "percent of total billed charges" }]}]} , { "description": "Partial mastectomy", "code_information": [ { "code": "19301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28399.5, "discounted_cash": 5862,"minimum": 1715,"maximum": 22719.6,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 22719.6, "standard_charge_percentage": 80.0000, "estimated_amount": 22719, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3607.66, "estimated_amount": 3607, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 7760.99, "estimated_amount": 7760, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5296.51, "standard_charge_percentage": 18.6500, "estimated_amount": 5296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 7760.99, "estimated_amount": 7760, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 7760.99, "estimated_amount": 7760, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6626.83, "estimated_amount": 6626, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 9560.31, "estimated_amount": 9560, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8519.85, "standard_charge_percentage": 30.0000, "estimated_amount": 8519, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5560.62, "standard_charge_percentage": 19.5800, "estimated_amount": 5560, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 22719.6, "standard_charge_percentage": 80.0000, "estimated_amount": 22719, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 7215.33, "estimated_amount": 7215, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 9019.16, "estimated_amount": 9019, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 9560.31, "estimated_amount": 9560, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5402.44, "standard_charge_percentage": 19.0200, "estimated_amount": 5402, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 6087.93, "estimated_amount": 6087, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 6313.41, "estimated_amount": 6313, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 9019.16, "estimated_amount": 9019, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4735.06, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 4509.58, "estimated_amount": 4509, "methodology": "fee schedule" }]}]} , { "description": "Mast simple complete", "code_information": [ { "code": "19303", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28309.1, "discounted_cash": 9984,"minimum": 1715,"maximum": 22647.3,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7680.06, "estimated_amount": 7680, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7680.06, "estimated_amount": 7680, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 15360.1, "estimated_amount": 15360, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 7680.06, "estimated_amount": 7680, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 16281.7, "estimated_amount": 16281, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5279.64, "standard_charge_percentage": 18.6500, "estimated_amount": 5279, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5542.91, "standard_charge_percentage": 19.5800, "estimated_amount": 5542, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 22647.3, "standard_charge_percentage": 80.0000, "estimated_amount": 22647, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 10368.1, "estimated_amount": 10368, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 13217.4, "estimated_amount": 13217, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 13217.4, "estimated_amount": 13217, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 7680.06, "estimated_amount": 7680, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8064.06, "estimated_amount": 8064, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 16281.7, "estimated_amount": 16281, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5385.23, "standard_charge_percentage": 19.0200, "estimated_amount": 5385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8492.72, "standard_charge_percentage": 30.0000, "estimated_amount": 8492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 7680.06, "estimated_amount": 7680, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6144.05, "estimated_amount": 6144, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 7680.06, "estimated_amount": 7680, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 12288.1, "estimated_amount": 12288, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7680.06, "estimated_amount": 7680, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 22647.3, "standard_charge_percentage": 80.0000, "estimated_amount": 22647, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 7680.06, "estimated_amount": 7680, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7680.06, "estimated_amount": 7680, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 13217.4, "estimated_amount": 13217, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10752.1, "estimated_amount": 10752, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 15360.1, "estimated_amount": 15360, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 11285.9, "estimated_amount": 11285, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 7680.06, "estimated_amount": 7680, "methodology": "fee schedule" }]}]} , { "description": "Hc Explore Wound,Neck", "code_information": [ { "code": "20100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1815.74, "discounted_cash": 779,"minimum": 338.64,"maximum": 1815.74,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1423.54, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1423, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 345.41, "standard_charge_percentage": 19.0200, "estimated_amount": 345, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1452.59, "standard_charge_percentage": 80.0000, "estimated_amount": 1452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1271.41, "estimated_amount": 1271, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 907.87, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 907, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1815.74, "estimated_amount": 1815, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 338.64, "standard_charge_percentage": 18.6500, "estimated_amount": 338, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1452.59, "standard_charge_percentage": 80.0000, "estimated_amount": 1452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 544.72, "standard_charge_percentage": 30.0000, "estimated_amount": 544, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1032.12, "estimated_amount": 1032, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 959.55, "estimated_amount": 959, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 839.61, "estimated_amount": 839, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1199.44, "estimated_amount": 1199, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 881.29, "estimated_amount": 881, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 629.71, "estimated_amount": 629, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1815.74, "estimated_amount": 1815, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1423.54, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1423, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 355.52, "standard_charge_percentage": 19.5800, "estimated_amount": 355, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1815.74, "estimated_amount": 1815, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 809.62, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 479.78, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1032.12, "estimated_amount": 1032, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1032.12, "estimated_amount": 1032, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1199.44, "estimated_amount": 1199, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1271.41, "estimated_amount": 1271, "methodology": "fee schedule" }]}]} , { "description": "Hc Explore Wound,Chest", "code_information": [ { "code": "20101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5773.63, "discounted_cash": 2800,"minimum": 1076.78,"maximum": 4618.9,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4526.53, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4526, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1732.09, "standard_charge_percentage": 30.0000, "estimated_amount": 1732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1130.48, "standard_charge_percentage": 19.5800, "estimated_amount": 1130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4618.9, "standard_charge_percentage": 80.0000, "estimated_amount": 4618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1723.37, "estimated_amount": 1723, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3446.74, "estimated_amount": 3446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4526.53, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4526, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2908.18, "estimated_amount": 2908, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2886.82, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2886, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1076.78, "standard_charge_percentage": 18.6500, "estimated_amount": 1076, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2261.92, "estimated_amount": 2261, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1098.32, "standard_charge_percentage": 19.0200, "estimated_amount": 1098, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4618.9, "standard_charge_percentage": 80.0000, "estimated_amount": 4618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3015.89, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3165.61, "estimated_amount": 3165, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" }]}]} , { "description": "Hc Explore Wound Abdomen/Flank/Back", "code_information": [ { "code": "20102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5773.63, "discounted_cash": 2800,"minimum": 1076.78,"maximum": 4618.9,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4526.53, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4526, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1732.09, "standard_charge_percentage": 30.0000, "estimated_amount": 1732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4618.9, "standard_charge_percentage": 80.0000, "estimated_amount": 4618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3015.89, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4526.53, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4526, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4308.42, "estimated_amount": 4308, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3165.61, "estimated_amount": 3165, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2261.92, "estimated_amount": 2261, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4566.93, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2886.82, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2886, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1076.78, "standard_charge_percentage": 18.6500, "estimated_amount": 1076, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1723.37, "estimated_amount": 1723, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1098.32, "standard_charge_percentage": 19.0200, "estimated_amount": 1098, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4618.9, "standard_charge_percentage": 80.0000, "estimated_amount": 4618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1130.48, "standard_charge_percentage": 19.5800, "estimated_amount": 1130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2908.18, "estimated_amount": 2908, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3707.4, "estimated_amount": 3707, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3446.74, "estimated_amount": 3446, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 2154.21, "estimated_amount": 2154, "methodology": "fee schedule" }]}]} , { "description": "Hc Explore Wound Extremity", "code_information": [ { "code": "20103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2159.45, "discounted_cash": 2480,"minimum": 402.74,"maximum": 14629.8,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2159.45, "estimated_amount": 2159, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1693.01, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1693, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 410.79, "standard_charge_percentage": 19.0200, "estimated_amount": 410, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1727.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1727, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 2159.45, "estimated_amount": 2159, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2159.45, "estimated_amount": 2159, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 2159.45, "estimated_amount": 2159, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 647.83, "standard_charge_percentage": 30.0000, "estimated_amount": 647, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 2159.45, "estimated_amount": 2159, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 2159.45, "estimated_amount": 2159, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 402.74, "standard_charge_percentage": 18.6500, "estimated_amount": 402, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1727.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1727, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 2159.45, "estimated_amount": 2159, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 2159.45, "estimated_amount": 2159, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2159.45, "estimated_amount": 2159, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5486.19, "standard_charge_percentage": 30.0000, "estimated_amount": 5486, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3580.65, "standard_charge_percentage": 19.5800, "estimated_amount": 3580, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2159.45, "estimated_amount": 2159, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1079.72, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1079, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1693.01, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1693, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 422.82, "standard_charge_percentage": 19.5800, "estimated_amount": 422, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2159.45, "estimated_amount": 2159, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 2159.45, "estimated_amount": 2159, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2159.45, "estimated_amount": 2159, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3410.58, "standard_charge_percentage": 18.6500, "estimated_amount": 3410, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3478.79, "standard_charge_percentage": 19.0200, "estimated_amount": 3478, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14629.8, "standard_charge_percentage": 80.0000, "estimated_amount": 14629, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14629.8, "standard_charge_percentage": 80.0000, "estimated_amount": 14629, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "Deep Muscle Biopsy", "code_information": [ { "code": "20205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13674, "discounted_cash": 4381,"minimum": 1715,"maximum": 10939.2,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2550.2, "standard_charge_percentage": 18.6500, "estimated_amount": 2550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2677.37, "standard_charge_percentage": 19.5800, "estimated_amount": 2677, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2601.21, "standard_charge_percentage": 19.0200, "estimated_amount": 2601, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10939.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4102.2, "standard_charge_percentage": 30.0000, "estimated_amount": 4102, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10939.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 6837, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 6837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" }]}]} , { "description": "INJECT INTO SPINAL ARTERY", "code_information": [ { "code": "20206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6863, "discounted_cash": 2480,"minimum": 1279.95,"maximum": 5490.4,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1279.95, "standard_charge_percentage": 18.6500, "estimated_amount": 1279, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1305.55, "standard_charge_percentage": 19.0200, "estimated_amount": 1305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5490.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1343.78, "standard_charge_percentage": 19.5800, "estimated_amount": 1343, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2058.9, "standard_charge_percentage": 30.0000, "estimated_amount": 2058, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5490.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3431.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3431, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "EPI STEROID INJ CERV/THORA-PC", "code_information": [ { "code": "20220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1797.12, "discounted_cash": 2480,"minimum": 335.16,"maximum": 1797.12,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1797.12, "estimated_amount": 1797, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1408.94, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1408, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 335.16, "standard_charge_percentage": 18.6500, "estimated_amount": 335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 351.88, "standard_charge_percentage": 19.5800, "estimated_amount": 351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1797.12, "estimated_amount": 1797, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1797.12, "estimated_amount": 1797, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1797.12, "estimated_amount": 1797, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1797.12, "estimated_amount": 1797, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1797.12, "estimated_amount": 1797, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1437.7, "standard_charge_percentage": 80.0000, "estimated_amount": 1437, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1797.12, "estimated_amount": 1797, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1797.12, "estimated_amount": 1797, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1797.12, "estimated_amount": 1797, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1797.12, "estimated_amount": 1797, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1797.12, "estimated_amount": 1797, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1797.12, "estimated_amount": 1797, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1408.94, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1408, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 341.87, "standard_charge_percentage": 19.0200, "estimated_amount": 341, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 539.14, "standard_charge_percentage": 30.0000, "estimated_amount": 539, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1797.12, "estimated_amount": 1797, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1797.12, "estimated_amount": 1797, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1797.12, "estimated_amount": 1797, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1797.12, "estimated_amount": 1797, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1797.12, "estimated_amount": 1797, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1797.12, "estimated_amount": 1797, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1797.12, "estimated_amount": 1797, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1797.12, "estimated_amount": 1797, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1797.12, "estimated_amount": 1797, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 898.56, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 898, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1437.7, "standard_charge_percentage": 80.0000, "estimated_amount": 1437, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1797.12, "estimated_amount": 1797, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1797.12, "estimated_amount": 1797, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1797.12, "estimated_amount": 1797, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1797.12, "estimated_amount": 1797, "methodology": "fee schedule" }]}]} , { "description": "Hc Bone Biopsy,Trocar/Needle Deep", "code_information": [ { "code": "20225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7035, "discounted_cash": 2480,"minimum": 1312.03,"maximum": 5628,"payers_information":[{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5628, "standard_charge_percentage": 80.0000, "estimated_amount": 5628, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3517.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1312.03, "standard_charge_percentage": 18.6500, "estimated_amount": 1312, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1338.27, "standard_charge_percentage": 19.0200, "estimated_amount": 1338, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5628, "standard_charge_percentage": 80.0000, "estimated_amount": 5628, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2110.5, "standard_charge_percentage": 30.0000, "estimated_amount": 2110, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1377.45, "standard_charge_percentage": 19.5800, "estimated_amount": 1377, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" }]}]} , { "description": "Hc Bone Biopsy,Excisional Superf", "code_information": [ { "code": "20240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11891.5, "discounted_cash": 4381,"minimum": 1715,"maximum": 9513.2,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3567.45, "standard_charge_percentage": 30.0000, "estimated_amount": 3567, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5945.75, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5945, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2262.12, "standard_charge_percentage": 19.0200, "estimated_amount": 2262, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2328.36, "standard_charge_percentage": 19.5800, "estimated_amount": 2328, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9513.2, "standard_charge_percentage": 80.0000, "estimated_amount": 9513, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9513.2, "standard_charge_percentage": 80.0000, "estimated_amount": 9513, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2217.76, "standard_charge_percentage": 18.6500, "estimated_amount": 2217, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "20245", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7212.5, "discounted_cash": 4381,"minimum": 1345.13,"maximum": 7145.5,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5770, "standard_charge_percentage": 80.0000, "estimated_amount": 5770, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5770, "standard_charge_percentage": 80.0000, "estimated_amount": 5770, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3606.25, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3606, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1345.13, "standard_charge_percentage": 18.6500, "estimated_amount": 1345, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1372.03, "standard_charge_percentage": 19.0200, "estimated_amount": 1372, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2163.75, "standard_charge_percentage": 30.0000, "estimated_amount": 2163, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1412.21, "standard_charge_percentage": 19.5800, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" }]}]} , { "description": "Hc Remove Fb Musc/Tendon, Simple", "code_information": [ { "code": "20520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5127.07, "discounted_cash": 2480,"minimum": 956.2,"maximum": 12312,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4019.62, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4019, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 956.2, "standard_charge_percentage": 18.6500, "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4101.66, "standard_charge_percentage": 80.0000, "estimated_amount": 4101, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4101.66, "standard_charge_percentage": 80.0000, "estimated_amount": 4101, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2563.53, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2563, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4019.62, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4019, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 975.32, "standard_charge_percentage": 19.0200, "estimated_amount": 975, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1538.12, "standard_charge_percentage": 30.0000, "estimated_amount": 1538, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1003.88, "standard_charge_percentage": 19.5800, "estimated_amount": 1003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "Hc Removal Of Foreign Body Deep/Complex", "code_information": [ { "code": "20525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8864.9, "discounted_cash": 4381,"minimum": 1653.3,"maximum": 7145.5,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1686.37, "standard_charge_percentage": 19.0200, "estimated_amount": 1686, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1653.3, "standard_charge_percentage": 18.6500, "estimated_amount": 1653, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7091.92, "standard_charge_percentage": 80.0000, "estimated_amount": 7091, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1735.75, "standard_charge_percentage": 19.5800, "estimated_amount": 1735, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4432.45, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4432, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2659.47, "standard_charge_percentage": 30.0000, "estimated_amount": 2659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7091.92, "standard_charge_percentage": 80.0000, "estimated_amount": 7091, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" }]}]} , { "description": "Hc Inject Tendon Sheath/Ligament", "code_information": [ { "code": "20550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1118.8, "discounted_cash": 451,"minimum": 208.66,"maximum": 1118.8,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1118.8, "estimated_amount": 1118, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 877.14, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 598.27, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 598.27, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 556.21, "estimated_amount": 556, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 877.14, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 486.68, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 736.98, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1118.8, "estimated_amount": 1118, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1118.8, "estimated_amount": 1118, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 208.66, "standard_charge_percentage": 18.6500, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 469.3, "estimated_amount": 469, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 278.1, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 695.26, "estimated_amount": 695, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 510.84, "estimated_amount": 510, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 365.01, "estimated_amount": 365, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 559.4, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 559, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1118.8, "estimated_amount": 1118, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 212.83, "standard_charge_percentage": 19.0200, "estimated_amount": 212, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 335.64, "standard_charge_percentage": 30.0000, "estimated_amount": 335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 219.06, "standard_charge_percentage": 19.5800, "estimated_amount": 219, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 598.27, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 695.26, "estimated_amount": 695, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 736.98, "estimated_amount": 736, "methodology": "fee schedule" }]}]} , { "description": "Hc Inject Trigger Point1-2 Muscle", "code_information": [ { "code": "20552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 922.46, "discounted_cash": 451,"minimum": 172.04,"maximum": 922.46,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 723.21, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 723, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 486.68, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 695.26, "estimated_amount": 695, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 736.98, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 922.46, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 922.46, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 723.21, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 723, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 175.48, "standard_charge_percentage": 19.0200, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 737.97, "standard_charge_percentage": 80.0000, "estimated_amount": 737, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 598.27, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 598.27, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 556.21, "estimated_amount": 556, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 922.46, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 276.74, "standard_charge_percentage": 30.0000, "estimated_amount": 276, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 180.62, "standard_charge_percentage": 19.5800, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 469.3, "estimated_amount": 469, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 278.1, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 510.84, "estimated_amount": 510, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 365.01, "estimated_amount": 365, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 922.46, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 461.23, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 461, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 172.04, "standard_charge_percentage": 18.6500, "estimated_amount": 172, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 737.97, "standard_charge_percentage": 80.0000, "estimated_amount": 737, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 598.27, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 695.26, "estimated_amount": 695, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 736.98, "estimated_amount": 736, "methodology": "fee schedule" }]}]} , { "description": "Hc Inject Trigger Points, > 3", "code_information": [ { "code": "20553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 922.46, "discounted_cash": 451,"minimum": 172.04,"maximum": 10939.2,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 723.21, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 723, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 276.74, "standard_charge_percentage": 30.0000, "estimated_amount": 276, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 278.1, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 598.27, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 598.27, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2550.2, "standard_charge_percentage": 18.6500, "estimated_amount": 2550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2677.37, "standard_charge_percentage": 19.5800, "estimated_amount": 2677, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 736.98, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 736.98, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 922.46, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 922.46, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 723.21, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 723, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 737.97, "standard_charge_percentage": 80.0000, "estimated_amount": 737, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 510.84, "estimated_amount": 510, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 180.62, "standard_charge_percentage": 19.5800, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 598.27, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 486.68, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 695.26, "estimated_amount": 695, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 736.98, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 736.98, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10939.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 469.3, "estimated_amount": 469, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 278.1, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 598.27, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 556.21, "estimated_amount": 556, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 486.68, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 461.23, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 461, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 922.46, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 922.46, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 172.04, "standard_charge_percentage": 18.6500, "estimated_amount": 172, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 175.48, "standard_charge_percentage": 19.0200, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 737.97, "standard_charge_percentage": 80.0000, "estimated_amount": 737, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 469.3, "estimated_amount": 469, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 556.21, "estimated_amount": 556, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 695.26, "estimated_amount": 695, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 365.01, "estimated_amount": 365, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2601.21, "standard_charge_percentage": 19.0200, "estimated_amount": 2601, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10939.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4102.2, "standard_charge_percentage": 30.0000, "estimated_amount": 4102, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 598.27, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 695.26, "estimated_amount": 695, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 6837, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 6837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 598.27, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 695.26, "estimated_amount": 695, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 510.84, "estimated_amount": 510, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 365.01, "estimated_amount": 365, "methodology": "fee schedule" }]}]} , { "description": "Hc Drain/Inject Small Joint/Bursa", "code_information": [ { "code": "20600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1215.91, "discounted_cash": 451,"minimum": 226.77,"maximum": 1215.91,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1215.91, "estimated_amount": 1215, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 607.96, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 607, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 953.27, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 953, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 695.26, "estimated_amount": 695, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 365.01, "estimated_amount": 365, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 736.98, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1215.91, "estimated_amount": 1215, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1215.91, "estimated_amount": 1215, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 953.27, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 953, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 238.08, "standard_charge_percentage": 19.5800, "estimated_amount": 238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 278.1, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 486.68, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 695.26, "estimated_amount": 695, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 510.84, "estimated_amount": 510, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 226.77, "standard_charge_percentage": 18.6500, "estimated_amount": 226, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 972.73, "standard_charge_percentage": 80.0000, "estimated_amount": 972, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 972.73, "standard_charge_percentage": 80.0000, "estimated_amount": 972, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 469.3, "estimated_amount": 469, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 598.27, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 556.21, "estimated_amount": 556, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1215.91, "estimated_amount": 1215, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 231.3, "standard_charge_percentage": 19.0200, "estimated_amount": 231, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 364.77, "standard_charge_percentage": 30.0000, "estimated_amount": 364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 598.27, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 598.27, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 736.98, "estimated_amount": 736, "methodology": "fee schedule" }]}]} , { "description": "Hc Drain/Inject Intermediate Joint/Bursa", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 706.73, "discounted_cash": 451,"minimum": 131.81,"maximum": 706.73,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 353.37, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 353, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 706.73, "estimated_amount": 706, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 134.44, "standard_charge_percentage": 19.0200, "estimated_amount": 134, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 565.38, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 565.38, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 365.01, "estimated_amount": 365, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 706.73, "estimated_amount": 706, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 706.73, "estimated_amount": 706, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 131.81, "standard_charge_percentage": 18.6500, "estimated_amount": 131, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 278.1, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 598.27, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 486.68, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 706.73, "estimated_amount": 706, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 706.73, "estimated_amount": 706, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 554.08, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 554, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 212.02, "standard_charge_percentage": 30.0000, "estimated_amount": 212, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 138.38, "standard_charge_percentage": 19.5800, "estimated_amount": 138, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 598.27, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 695.26, "estimated_amount": 695, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 510.84, "estimated_amount": 510, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 706.73, "estimated_amount": 706, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 554.08, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 554, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 469.3, "estimated_amount": 469, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 598.27, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 556.21, "estimated_amount": 556, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 695.26, "estimated_amount": 695, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" }]}]} , { "description": "Hc Arthrocentesis Aspir&/Inj Interm Jt/Burs W/Us", "code_information": [ { "code": "20606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3294.5, "discounted_cash": 1060,"minimum": 614.42,"maximum": 3147,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 988.35, "standard_charge_percentage": 30.0000, "estimated_amount": 988, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 2582.89, "standard_charge_percentage": 78.4000, "estimated_amount": 2582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 815.55, "estimated_amount": 815, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 815.55, "estimated_amount": 815, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1403.56, "estimated_amount": 1403, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1631.1, "estimated_amount": 1631, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 815.55, "estimated_amount": 815, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 2800.32, "standard_charge_percentage": 85.0000, "estimated_amount": 2800, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 626.71, "standard_charge_percentage": 19.0200, "estimated_amount": 626, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 2582.89, "standard_charge_percentage": 78.4000, "estimated_amount": 2582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1100.99, "estimated_amount": 1100, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 815.55, "estimated_amount": 815, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 652.44, "estimated_amount": 652, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1403.56, "estimated_amount": 1403, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 815.55, "estimated_amount": 815, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1728.97, "estimated_amount": 1728, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1728.97, "estimated_amount": 1728, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1647.25, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1647, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 2800.32, "standard_charge_percentage": 85.0000, "estimated_amount": 2800, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 815.55, "estimated_amount": 815, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1304.88, "estimated_amount": 1304, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1141.77, "estimated_amount": 1141, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 815.55, "estimated_amount": 815, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 815.55, "estimated_amount": 815, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 614.42, "standard_charge_percentage": 18.6500, "estimated_amount": 614, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2635.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 645.06, "standard_charge_percentage": 19.5800, "estimated_amount": 645, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2635.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 815.55, "estimated_amount": 815, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 815.55, "estimated_amount": 815, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1403.56, "estimated_amount": 1403, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1631.1, "estimated_amount": 1631, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1198.45, "estimated_amount": 1198, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 856.33, "estimated_amount": 856, "methodology": "fee schedule" }]}]} , { "description": "Hc Asp/Drain Large Joint/Bursa", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1215.91, "discounted_cash": 451,"minimum": 226.77,"maximum": 12312,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1215.91, "estimated_amount": 1215, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1215.91, "estimated_amount": 1215, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1215.91, "estimated_amount": 1215, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 953.27, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 953, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 364.77, "standard_charge_percentage": 30.0000, "estimated_amount": 364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 238.08, "standard_charge_percentage": 19.5800, "estimated_amount": 238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 695.26, "estimated_amount": 695, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 365.01, "estimated_amount": 365, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 736.98, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 278.1, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 598.27, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 556.21, "estimated_amount": 556, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 486.68, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1215.91, "estimated_amount": 1215, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 231.3, "standard_charge_percentage": 19.0200, "estimated_amount": 231, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 278.1, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 486.68, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 695.26, "estimated_amount": 695, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 510.84, "estimated_amount": 510, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 607.96, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 607, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 953.27, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 953, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 226.77, "standard_charge_percentage": 18.6500, "estimated_amount": 226, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 972.73, "standard_charge_percentage": 80.0000, "estimated_amount": 972, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 972.73, "standard_charge_percentage": 80.0000, "estimated_amount": 972, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 598.27, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 598.27, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 736.98, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 695.26, "estimated_amount": 695, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 365.01, "estimated_amount": 365, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 736.98, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 736.98, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 469.3, "estimated_amount": 469, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 598.27, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 556.21, "estimated_amount": 556, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 598.27, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 695.26, "estimated_amount": 695, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 510.84, "estimated_amount": 510, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 469.3, "estimated_amount": 469, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 598.27, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Hc Arthrocentesis Aspir&/Inj Major Jt/Bursa W/Us", "code_information": [ { "code": "20611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1305.85, "discounted_cash": 451,"minimum": 243.54,"maximum": 1305.85,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1305.85, "estimated_amount": 1305, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1305.85, "estimated_amount": 1305, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 278.1, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 486.68, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 510.84, "estimated_amount": 510, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 652.92, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 652, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1023.79, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1023, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1023.79, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1023, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 243.54, "standard_charge_percentage": 18.6500, "estimated_amount": 243, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 248.41, "standard_charge_percentage": 19.0200, "estimated_amount": 248, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 365.01, "estimated_amount": 365, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 736.98, "estimated_amount": 736, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1305.85, "estimated_amount": 1305, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1044.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1044, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 391.75, "standard_charge_percentage": 30.0000, "estimated_amount": 391, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 255.69, "standard_charge_percentage": 19.5800, "estimated_amount": 255, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 469.3, "estimated_amount": 469, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 598.27, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 556.21, "estimated_amount": 556, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1305.85, "estimated_amount": 1305, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1044.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1044, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 598.27, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 598.27, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 695.26, "estimated_amount": 695, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 695.26, "estimated_amount": 695, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 347.63, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 736.98, "estimated_amount": 736, "methodology": "fee schedule" }]}]} , { "description": "Hc Removal Of Implant, Superficial", "code_information": [ { "code": "20670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6863, "discounted_cash": 2480,"minimum": 1279.95,"maximum": 5490.4,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1279.95, "standard_charge_percentage": 18.6500, "estimated_amount": 1279, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1305.55, "standard_charge_percentage": 19.0200, "estimated_amount": 1305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1343.78, "standard_charge_percentage": 19.5800, "estimated_amount": 1343, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5490.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3431.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3431, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5490.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2058.9, "standard_charge_percentage": 30.0000, "estimated_amount": 2058, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" }]}]} , { "description": "Hc Removal Implant Deep", "code_information": [ { "code": "20680", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11850, "discounted_cash": 4381,"minimum": 1715,"maximum": 22027.8,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 22027.8, "standard_charge_percentage": 80.0000, "estimated_amount": 22027, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5391.31, "standard_charge_percentage": 19.5800, "estimated_amount": 5391, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2210.02, "standard_charge_percentage": 18.6500, "estimated_amount": 2210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5925, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5925, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2254.23, "standard_charge_percentage": 19.0200, "estimated_amount": 2254, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9480, "standard_charge_percentage": 80.0000, "estimated_amount": 9480, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8260.44, "standard_charge_percentage": 30.0000, "estimated_amount": 8260, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 22027.8, "standard_charge_percentage": 80.0000, "estimated_amount": 22027, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9480, "standard_charge_percentage": 80.0000, "estimated_amount": 9480, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3555, "standard_charge_percentage": 30.0000, "estimated_amount": 3555, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2320.23, "standard_charge_percentage": 19.5800, "estimated_amount": 2320, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5135.24, "standard_charge_percentage": 18.6500, "estimated_amount": 5135, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5237.95, "standard_charge_percentage": 19.0200, "estimated_amount": 5237, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "20690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40663, "discounted_cash": 10936,"minimum": 1715,"maximum": 32530.4,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32530.4, "standard_charge_percentage": 80.0000, "estimated_amount": 32530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 7961.82, "standard_charge_percentage": 19.5800, "estimated_amount": 7961, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 7583.65, "standard_charge_percentage": 18.6500, "estimated_amount": 7583, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32530.4, "standard_charge_percentage": 80.0000, "estimated_amount": 32530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 7735.32, "standard_charge_percentage": 19.0200, "estimated_amount": 7735, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12198.9, "standard_charge_percentage": 30.0000, "estimated_amount": 12198, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "20692", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35050.6, "discounted_cash": 19698,"minimum": 1715,"maximum": 32123.8,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 20456.2, "estimated_amount": 20456, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 12122.2, "estimated_amount": 12122, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 15910.4, "estimated_amount": 15910, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 32123.8, "estimated_amount": 32123, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 6667.68, "standard_charge_percentage": 19.0200, "estimated_amount": 6667, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 26077.8, "estimated_amount": 26077, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 22266.9, "estimated_amount": 22266, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 6536.94, "standard_charge_percentage": 18.6500, "estimated_amount": 6536, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 6862.91, "standard_charge_percentage": 19.5800, "estimated_amount": 6862, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 28040.5, "standard_charge_percentage": 80.0000, "estimated_amount": 28040, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 26077.8, "estimated_amount": 26077, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 26077.8, "estimated_amount": 26077, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 24244.4, "estimated_amount": 24244, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 21213.8, "estimated_amount": 21213, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 32123.8, "estimated_amount": 32123, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 28040.5, "standard_charge_percentage": 80.0000, "estimated_amount": 28040, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 10515.2, "standard_charge_percentage": 30.0000, "estimated_amount": 10515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 30305.5, "estimated_amount": 30305, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 30305.5, "estimated_amount": 30305, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" }]}]} , { "description": "Hc Adjustment/Revj Xtrnl Fixation System Req Anes", "code_information": [ { "code": "20693", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7575, "discounted_cash": 10936,"minimum": 1412.74,"maximum": 31161.6,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 7575, "estimated_amount": 7575, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7575, "estimated_amount": 7575, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 7575, "estimated_amount": 7575, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 7575, "estimated_amount": 7575, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 7575, "estimated_amount": 7575, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 7575, "estimated_amount": 7575, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7575, "estimated_amount": 7575, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 7575, "estimated_amount": 7575, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 7575, "estimated_amount": 7575, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 7575, "estimated_amount": 7575, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7575, "estimated_amount": 7575, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7575, "estimated_amount": 7575, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 11685.6, "standard_charge_percentage": 30.0000, "estimated_amount": 11685, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 31161.6, "standard_charge_percentage": 80.0000, "estimated_amount": 31161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6060, "standard_charge_percentage": 80.0000, "estimated_amount": 6060, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2272.5, "standard_charge_percentage": 30.0000, "estimated_amount": 2272, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7575, "estimated_amount": 7575, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 7575, "estimated_amount": 7575, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1440.99, "standard_charge_percentage": 19.0200, "estimated_amount": 1440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1483.18, "standard_charge_percentage": 19.5800, "estimated_amount": 1483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 7575, "estimated_amount": 7575, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 7575, "estimated_amount": 7575, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 7575, "estimated_amount": 7575, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 7409.84, "standard_charge_percentage": 19.0200, "estimated_amount": 7409, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 31161.6, "standard_charge_percentage": 80.0000, "estimated_amount": 31161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3787.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3787, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1412.74, "standard_charge_percentage": 18.6500, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6060, "standard_charge_percentage": 80.0000, "estimated_amount": 6060, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7575, "estimated_amount": 7575, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7575, "estimated_amount": 7575, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 7575, "estimated_amount": 7575, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7575, "estimated_amount": 7575, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7575, "estimated_amount": 7575, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 7264.55, "standard_charge_percentage": 18.6500, "estimated_amount": 7264, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 7626.8, "standard_charge_percentage": 19.5800, "estimated_amount": 7626, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" }]}]} , { "description": "Hc Remove Extern Bone Fix Dev W Anesth", "code_information": [ { "code": "20694", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6776.95, "discounted_cash": 2450,"minimum": 1263.9,"maximum": 15925.9,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1289.18, "standard_charge_percentage": 19.0200, "estimated_amount": 1289, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2033.09, "standard_charge_percentage": 30.0000, "estimated_amount": 2033, "methodology": "percent of total billed charges" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 15925.9, "standard_charge_percentage": 80.0000, "estimated_amount": 15925, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 15925.9, "standard_charge_percentage": 80.0000, "estimated_amount": 15925, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3388.47, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3388, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5421.56, "standard_charge_percentage": 80.0000, "estimated_amount": 5421, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3786.98, "standard_charge_percentage": 19.0200, "estimated_amount": 3786, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3897.87, "standard_charge_percentage": 19.5800, "estimated_amount": 3897, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1263.9, "standard_charge_percentage": 18.6500, "estimated_amount": 1263, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5421.56, "standard_charge_percentage": 80.0000, "estimated_amount": 5421, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1326.93, "standard_charge_percentage": 19.5800, "estimated_amount": 1326, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5972.22, "standard_charge_percentage": 30.0000, "estimated_amount": 5972, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3712.73, "standard_charge_percentage": 18.6500, "estimated_amount": 3712, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "20700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9376.25,"minimum": 1715,"maximum": 7501,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2812.88, "standard_charge_percentage": 30.0000, "estimated_amount": 2812, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7501, "standard_charge_percentage": 80.0000, "estimated_amount": 7501, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7501, "standard_charge_percentage": 80.0000, "estimated_amount": 7501, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1835.87, "standard_charge_percentage": 19.5800, "estimated_amount": 1835, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1748.67, "standard_charge_percentage": 18.6500, "estimated_amount": 1748, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1783.64, "standard_charge_percentage": 19.0200, "estimated_amount": 1783, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "20702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9818.77,"minimum": 1715,"maximum": 7855.02,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1831.2, "standard_charge_percentage": 18.6500, "estimated_amount": 1831, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2945.63, "standard_charge_percentage": 30.0000, "estimated_amount": 2945, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7855.02, "standard_charge_percentage": 80.0000, "estimated_amount": 7855, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1867.82, "standard_charge_percentage": 19.0200, "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7855.02, "standard_charge_percentage": 80.0000, "estimated_amount": 7855, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1922.52, "standard_charge_percentage": 19.5800, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "20705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29456.3,"minimum": 1715,"maximum": 23565,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5767.53, "standard_charge_percentage": 19.5800, "estimated_amount": 5767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 23565, "standard_charge_percentage": 80.0000, "estimated_amount": 23565, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5493.59, "standard_charge_percentage": 18.6500, "estimated_amount": 5493, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5603.46, "standard_charge_percentage": 19.0200, "estimated_amount": 5603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8836.88, "standard_charge_percentage": 30.0000, "estimated_amount": 8836, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 23565, "standard_charge_percentage": 80.0000, "estimated_amount": 23565, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "20900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17845.4, "discounted_cash": 10936,"minimum": 1715,"maximum": 17835.3,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8922.71, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14276.3, "standard_charge_percentage": 80.0000, "estimated_amount": 14276, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3394.73, "standard_charge_percentage": 19.0200, "estimated_amount": 3394, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3328.17, "standard_charge_percentage": 18.6500, "estimated_amount": 3328, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5353.63, "standard_charge_percentage": 30.0000, "estimated_amount": 5353, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3494.13, "standard_charge_percentage": 19.5800, "estimated_amount": 3494, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14276.3, "standard_charge_percentage": 80.0000, "estimated_amount": 14276, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "20902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17266.2, "discounted_cash": 10936,"minimum": 1715,"maximum": 17266.2,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3284.55, "standard_charge_percentage": 19.0200, "estimated_amount": 3284, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3380.72, "standard_charge_percentage": 19.5800, "estimated_amount": 3380, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3220.15, "standard_charge_percentage": 18.6500, "estimated_amount": 3220, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8633.1, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8633, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13813, "standard_charge_percentage": 80.0000, "estimated_amount": 13812, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5179.86, "standard_charge_percentage": 30.0000, "estimated_amount": 5179, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13813, "standard_charge_percentage": 80.0000, "estimated_amount": 13812, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17266.2, "estimated_amount": 17266, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17266.2, "estimated_amount": 17266, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "20930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18926,"minimum": 1715,"maximum": 15140.8,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3705.71, "standard_charge_percentage": 19.5800, "estimated_amount": 3705, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3600.29, "standard_charge_percentage": 19.0200, "estimated_amount": 3600, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3529.7, "standard_charge_percentage": 18.6500, "estimated_amount": 3529, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 15140.8, "standard_charge_percentage": 80.0000, "estimated_amount": 15140, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5677.8, "standard_charge_percentage": 30.0000, "estimated_amount": 5677, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 15140.8, "standard_charge_percentage": 80.0000, "estimated_amount": 15140, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "20931", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7200.57,"minimum": 1342.91,"maximum": 5760.46,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2160.17, "standard_charge_percentage": 30.0000, "estimated_amount": 2160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1409.87, "standard_charge_percentage": 19.5800, "estimated_amount": 1409, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5760.46, "standard_charge_percentage": 80.0000, "estimated_amount": 5760, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1342.91, "standard_charge_percentage": 18.6500, "estimated_amount": 1342, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1369.76, "standard_charge_percentage": 19.0200, "estimated_amount": 1369, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5760.46, "standard_charge_percentage": 80.0000, "estimated_amount": 5760, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "20936", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5475.69,"minimum": 1021.22,"maximum": 5378,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4292.94, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4292.94, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1021.22, "standard_charge_percentage": 18.6500, "estimated_amount": 1021, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1642.71, "standard_charge_percentage": 30.0000, "estimated_amount": 1642, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1072.14, "standard_charge_percentage": 19.5800, "estimated_amount": 1072, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1041.64, "standard_charge_percentage": 19.0200, "estimated_amount": 1041, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4380.55, "standard_charge_percentage": 80.0000, "estimated_amount": 4380, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4380.55, "standard_charge_percentage": 80.0000, "estimated_amount": 4380, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "20937", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4697.87,"minimum": 876.15,"maximum": 4697.87,"payers_information":[{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3758.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3758, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4697.87, "estimated_amount": 4697, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3683.13, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3683, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 893.68, "standard_charge_percentage": 19.0200, "estimated_amount": 893, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3758.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1409.36, "standard_charge_percentage": 30.0000, "estimated_amount": 1409, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 919.84, "standard_charge_percentage": 19.5800, "estimated_amount": 919, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4697.87, "estimated_amount": 4697, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3683.13, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3683, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 876.15, "standard_charge_percentage": 18.6500, "estimated_amount": 876, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "20938", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5770,"minimum": 1076.1,"maximum": 5378,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4523.68, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4523, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1129.77, "standard_charge_percentage": 19.5800, "estimated_amount": 1129, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4523.68, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4523, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1097.63, "standard_charge_percentage": 19.0200, "estimated_amount": 1097, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1076.1, "standard_charge_percentage": 18.6500, "estimated_amount": 1076, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1731, "standard_charge_percentage": 30.0000, "estimated_amount": 1731, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4616, "standard_charge_percentage": 80.0000, "estimated_amount": 4616, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4616, "standard_charge_percentage": 80.0000, "estimated_amount": 4616, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "20985", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50854,"minimum": 1715,"maximum": 40683.2,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 9484.27, "standard_charge_percentage": 18.6500, "estimated_amount": 9484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 40683.2, "standard_charge_percentage": 80.0000, "estimated_amount": 40683, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 15256.2, "standard_charge_percentage": 30.0000, "estimated_amount": 15256, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 25427, "standard_charge_percentage": 50.0000, "estimated_amount": 25427, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 40683.2, "standard_charge_percentage": 80.0000, "estimated_amount": 40683, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 9673.96, "standard_charge_percentage": 19.0200, "estimated_amount": 9673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 9957.21, "standard_charge_percentage": 19.5800, "estimated_amount": 9957, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "20999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27479.6, "discounted_cash": 367,"minimum": 225.99,"maximum": 21983.7,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8243.89, "standard_charge_percentage": 30.0000, "estimated_amount": 8243, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 21983.7, "standard_charge_percentage": 80.0000, "estimated_amount": 21983, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 21983.7, "standard_charge_percentage": 80.0000, "estimated_amount": 21983, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5124.95, "standard_charge_percentage": 18.6500, "estimated_amount": 5124, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5227.45, "standard_charge_percentage": 19.0200, "estimated_amount": 5227, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5380.51, "standard_charge_percentage": 19.5800, "estimated_amount": 5380, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Exc Face Les Sc <2 Cm", "code_information": [ { "code": "21011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 2480,"minimum": 1526.47,"maximum": 12312,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" }]}]} , { "description": "Exc face les sbq 2 cm/>", "code_information": [ { "code": "21012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16929, "discounted_cash": 2480,"minimum": 1526.47,"maximum": 13543.2,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3157.26, "standard_charge_percentage": 18.6500, "estimated_amount": 3157, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3220.4, "standard_charge_percentage": 19.0200, "estimated_amount": 3220, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3314.7, "standard_charge_percentage": 19.5800, "estimated_amount": 3314, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13543.2, "standard_charge_percentage": 80.0000, "estimated_amount": 13543, "methodology": "percent of total billed charges" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8464.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8464, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5078.7, "standard_charge_percentage": 30.0000, "estimated_amount": 5078, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13543.2, "standard_charge_percentage": 80.0000, "estimated_amount": 13543, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "21013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 2480,"minimum": 1526.47,"maximum": 12312,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "Exc face tum deep 2 cm/>", "code_information": [ { "code": "21014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17955, "discounted_cash": 4381,"minimum": 1715,"maximum": 14364,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3348.61, "standard_charge_percentage": 18.6500, "estimated_amount": 3348, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3515.59, "standard_charge_percentage": 19.5800, "estimated_amount": 3515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5386.5, "standard_charge_percentage": 30.0000, "estimated_amount": 5386, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3415.58, "standard_charge_percentage": 19.0200, "estimated_amount": 3415, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14364, "standard_charge_percentage": 80.0000, "estimated_amount": 14364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8977.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8977, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14364, "standard_charge_percentage": 80.0000, "estimated_amount": 14364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" }]}]} , { "description": "Hc Graft Ear Crtlg Autogenous Nose/Ear", "code_information": [ { "code": "21235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15375.4, "discounted_cash": 9056,"minimum": 1715,"maximum": 14769.3,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12300.3, "standard_charge_percentage": 80.0000, "estimated_amount": 12300, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 11989.6, "estimated_amount": 11989, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7687.7, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7687, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2867.51, "standard_charge_percentage": 18.6500, "estimated_amount": 2867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3010.5, "standard_charge_percentage": 19.5800, "estimated_amount": 3010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5573.3, "estimated_amount": 5573, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9753.28, "estimated_amount": 9753, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2924.86, "standard_charge_percentage": 19.0200, "estimated_amount": 2924, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 9404.95, "estimated_amount": 9404, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 11989.6, "estimated_amount": 11989, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 13933.3, "estimated_amount": 13933, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10237.5, "estimated_amount": 10237, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 14769.3, "estimated_amount": 14769, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4612.62, "standard_charge_percentage": 30.0000, "estimated_amount": 4612, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12300.3, "standard_charge_percentage": 80.0000, "estimated_amount": 12300, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 11989.6, "estimated_amount": 11989, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 11146.6, "estimated_amount": 11146, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 13933.3, "estimated_amount": 13933, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 7314.96, "estimated_amount": 7314, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 14769.3, "estimated_amount": 14769, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Nose Xf Wo Stabil", "code_information": [ { "code": "21315", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4767.75, "discounted_cash": 2267,"minimum": 889.19,"maximum": 4052.59,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 889.19, "standard_charge_percentage": 18.6500, "estimated_amount": 889, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 906.97, "standard_charge_percentage": 19.0200, "estimated_amount": 906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1430.33, "standard_charge_percentage": 30.0000, "estimated_amount": 1430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1395.55, "estimated_amount": 1395, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3488.88, "estimated_amount": 3488, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2383.88, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2383, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 4052.59, "standard_charge_percentage": 85.0000, "estimated_amount": 4052, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3814.2, "standard_charge_percentage": 80.0000, "estimated_amount": 3814, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3002.18, "estimated_amount": 3002, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3002.18, "estimated_amount": 3002, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3002.18, "estimated_amount": 3002, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3488.88, "estimated_amount": 3488, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 4052.59, "standard_charge_percentage": 85.0000, "estimated_amount": 4052, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2354.99, "estimated_amount": 2354, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 2791.1, "estimated_amount": 2791, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2442.22, "estimated_amount": 2442, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1831.66, "estimated_amount": 1831, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3698.21, "estimated_amount": 3698, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3698.21, "estimated_amount": 3698, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 933.53, "standard_charge_percentage": 19.5800, "estimated_amount": 933, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3737.92, "standard_charge_percentage": 78.4000, "estimated_amount": 3737, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3737.92, "standard_charge_percentage": 78.4000, "estimated_amount": 3737, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3814.2, "standard_charge_percentage": 80.0000, "estimated_amount": 3814, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2563.45, "estimated_amount": 2563, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Nose Fx W Stabil", "code_information": [ { "code": "21320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8316.89, "discounted_cash": 4964,"minimum": 1551.1,"maximum": 8096.77,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1551.1, "standard_charge_percentage": 18.6500, "estimated_amount": 1551, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 7069.36, "standard_charge_percentage": 85.0000, "estimated_amount": 7069, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1628.45, "standard_charge_percentage": 19.5800, "estimated_amount": 1628, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 6520.44, "standard_charge_percentage": 78.4000, "estimated_amount": 6520, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6572.89, "estimated_amount": 6572, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7638.46, "estimated_amount": 7638, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7638.46, "estimated_amount": 7638, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4010.19, "estimated_amount": 4010, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8096.77, "estimated_amount": 8096, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6572.89, "estimated_amount": 6572, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5612.36, "estimated_amount": 5612, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4158.44, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4158, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 7069.36, "standard_charge_percentage": 85.0000, "estimated_amount": 7069, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1582.12, "standard_charge_percentage": 19.0200, "estimated_amount": 1582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5155.96, "estimated_amount": 5155, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3055.38, "estimated_amount": 3055, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6110.77, "estimated_amount": 6110, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6653.51, "standard_charge_percentage": 80.0000, "estimated_amount": 6653, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2495.07, "standard_charge_percentage": 30.0000, "estimated_amount": 2495, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 6520.44, "standard_charge_percentage": 78.4000, "estimated_amount": 6520, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6653.51, "standard_charge_percentage": 80.0000, "estimated_amount": 6653, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6572.89, "estimated_amount": 6572, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5346.92, "estimated_amount": 5346, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8096.77, "estimated_amount": 8096, "methodology": "fee schedule" }]}]} , { "description": "OPEN TX NOSE FX WSKELE FIXJ", "code_information": [ { "code": "21330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23085, "discounted_cash": 9056,"minimum": 1715,"maximum": 18468,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 9404.95, "estimated_amount": 9404, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 11989.6, "estimated_amount": 11989, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10237.5, "estimated_amount": 10237, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6925.5, "standard_charge_percentage": 30.0000, "estimated_amount": 6925, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5573.3, "estimated_amount": 5573, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 11989.6, "estimated_amount": 11989, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 13933.3, "estimated_amount": 13933, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 7314.96, "estimated_amount": 7314, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 14769.3, "estimated_amount": 14769, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4305.35, "standard_charge_percentage": 18.6500, "estimated_amount": 4305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4520.04, "standard_charge_percentage": 19.5800, "estimated_amount": 4520, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 11989.6, "estimated_amount": 11989, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 11146.6, "estimated_amount": 11146, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 13933.3, "estimated_amount": 13933, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 14769.3, "estimated_amount": 14769, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4391.46, "standard_charge_percentage": 19.0200, "estimated_amount": 4391, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 18468, "standard_charge_percentage": 80.0000, "estimated_amount": 18468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 18468, "standard_charge_percentage": 80.0000, "estimated_amount": 18468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9753.28, "estimated_amount": 9753, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "21346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11542.5, "discounted_cash": 9056,"minimum": 1715,"maximum": 11542.5,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9753.28, "estimated_amount": 9753, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2260.02, "standard_charge_percentage": 19.5800, "estimated_amount": 2260, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 9404.95, "estimated_amount": 9404, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 11146.6, "estimated_amount": 11146, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10237.5, "estimated_amount": 10237, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5573.3, "estimated_amount": 5573, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5771.25, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2152.68, "standard_charge_percentage": 18.6500, "estimated_amount": 2152, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2195.73, "standard_charge_percentage": 19.0200, "estimated_amount": 2195, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9234, "standard_charge_percentage": 80.0000, "estimated_amount": 9234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3462.75, "standard_charge_percentage": 30.0000, "estimated_amount": 3462, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9234, "standard_charge_percentage": 80.0000, "estimated_amount": 9234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 7314.96, "estimated_amount": 7314, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Fx Orbit Wo Manip", "code_information": [ { "code": "21400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1815.74, "discounted_cash": 779,"minimum": 338.64,"maximum": 1815.74,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1815.74, "estimated_amount": 1815, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 355.52, "standard_charge_percentage": 19.5800, "estimated_amount": 355, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 479.78, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1032.12, "estimated_amount": 1032, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 839.61, "estimated_amount": 839, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 881.29, "estimated_amount": 881, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1423.54, "standard_charge_percentage": 78.4000, "estimated_amount": 1423, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1032.12, "estimated_amount": 1032, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1032.12, "estimated_amount": 1032, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1199.44, "estimated_amount": 1199, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1271.41, "estimated_amount": 1271, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1815.74, "estimated_amount": 1815, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1543.38, "standard_charge_percentage": 85.0000, "estimated_amount": 1543, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 345.41, "standard_charge_percentage": 19.0200, "estimated_amount": 345, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1452.59, "standard_charge_percentage": 80.0000, "estimated_amount": 1452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1423.54, "standard_charge_percentage": 78.4000, "estimated_amount": 1423, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1199.44, "estimated_amount": 1199, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1271.41, "estimated_amount": 1271, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 907.87, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 907, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 338.64, "standard_charge_percentage": 18.6500, "estimated_amount": 338, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1543.38, "standard_charge_percentage": 85.0000, "estimated_amount": 1543, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 544.72, "standard_charge_percentage": 30.0000, "estimated_amount": 544, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1452.59, "standard_charge_percentage": 80.0000, "estimated_amount": 1452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 809.62, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 959.55, "estimated_amount": 959, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 629.71, "estimated_amount": 629, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Mandible Fx Wo Manip", "code_information": [ { "code": "21450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1815.74, "discounted_cash": 779,"minimum": 338.64,"maximum": 1815.74,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 907.87, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 907, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 338.64, "standard_charge_percentage": 18.6500, "estimated_amount": 338, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1543.38, "standard_charge_percentage": 85.0000, "estimated_amount": 1543, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 355.52, "standard_charge_percentage": 19.5800, "estimated_amount": 355, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1423.54, "standard_charge_percentage": 78.4000, "estimated_amount": 1423, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1032.12, "estimated_amount": 1032, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1271.41, "estimated_amount": 1271, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1815.74, "estimated_amount": 1815, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1543.38, "standard_charge_percentage": 85.0000, "estimated_amount": 1543, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 345.41, "standard_charge_percentage": 19.0200, "estimated_amount": 345, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1423.54, "standard_charge_percentage": 78.4000, "estimated_amount": 1423, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1452.59, "standard_charge_percentage": 80.0000, "estimated_amount": 1452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 479.78, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1032.12, "estimated_amount": 1032, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 959.55, "estimated_amount": 959, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 839.61, "estimated_amount": 839, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1199.44, "estimated_amount": 1199, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 881.29, "estimated_amount": 881, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 544.72, "standard_charge_percentage": 30.0000, "estimated_amount": 544, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1815.74, "estimated_amount": 1815, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1452.59, "standard_charge_percentage": 80.0000, "estimated_amount": 1452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 809.62, "estimated_amount": 809, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1032.12, "estimated_amount": 1032, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1199.44, "estimated_amount": 1199, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 629.71, "estimated_amount": 629, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 599.72, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1271.41, "estimated_amount": 1271, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Mandible Fx W Manip", "code_information": [ { "code": "21451", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4767.75, "discounted_cash": 2267,"minimum": 889.19,"maximum": 4052.59,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 4052.59, "standard_charge_percentage": 85.0000, "estimated_amount": 4052, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 906.97, "standard_charge_percentage": 19.0200, "estimated_amount": 906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1430.33, "standard_charge_percentage": 30.0000, "estimated_amount": 1430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 933.53, "standard_charge_percentage": 19.5800, "estimated_amount": 933, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1395.55, "estimated_amount": 1395, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2563.45, "estimated_amount": 2563, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 4052.59, "standard_charge_percentage": 85.0000, "estimated_amount": 4052, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3814.2, "standard_charge_percentage": 80.0000, "estimated_amount": 3814, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3737.92, "standard_charge_percentage": 78.4000, "estimated_amount": 3737, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3737.92, "standard_charge_percentage": 78.4000, "estimated_amount": 3737, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3002.18, "estimated_amount": 3002, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3002.18, "estimated_amount": 3002, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3488.88, "estimated_amount": 3488, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2383.88, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2383, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 889.19, "standard_charge_percentage": 18.6500, "estimated_amount": 889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2354.99, "estimated_amount": 2354, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 2791.1, "estimated_amount": 2791, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2442.22, "estimated_amount": 2442, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3488.88, "estimated_amount": 3488, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1831.66, "estimated_amount": 1831, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3698.21, "estimated_amount": 3698, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3698.21, "estimated_amount": 3698, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3814.2, "standard_charge_percentage": 80.0000, "estimated_amount": 3814, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3002.18, "estimated_amount": 3002, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "21462", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18272.8, "discounted_cash": 9056,"minimum": 1715,"maximum": 14769.3,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 11989.6, "estimated_amount": 11989, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5667, "estimated_amount": 5667, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3407.88, "standard_charge_percentage": 18.6500, "estimated_amount": 3407, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5481.84, "standard_charge_percentage": 30.0000, "estimated_amount": 5481, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 11989.6, "estimated_amount": 11989, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 13933.3, "estimated_amount": 13933, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 14769.3, "estimated_amount": 14769, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14618.3, "standard_charge_percentage": 80.0000, "estimated_amount": 14618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 11146.6, "estimated_amount": 11146, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 13933.3, "estimated_amount": 13933, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 7314.96, "estimated_amount": 7314, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3476.04, "standard_charge_percentage": 19.0200, "estimated_amount": 3476, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3577.82, "standard_charge_percentage": 19.5800, "estimated_amount": 3577, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14618.3, "standard_charge_percentage": 80.0000, "estimated_amount": 14618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 9404.95, "estimated_amount": 9404, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5573.3, "estimated_amount": 5573, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 11989.6, "estimated_amount": 11989, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9753.28, "estimated_amount": 9753, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10237.5, "estimated_amount": 10237, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 6966.63, "estimated_amount": 6966, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 14769.3, "estimated_amount": 14769, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Temporomandibl Disloc", "code_information": [ { "code": "21480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 968.12, "discounted_cash": 367,"minimum": 180.55,"maximum": 968.12,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 968.12, "estimated_amount": 968, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 290.44, "standard_charge_percentage": 30.0000, "estimated_amount": 290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 189.56, "standard_charge_percentage": 19.5800, "estimated_amount": 189, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 180.55, "standard_charge_percentage": 18.6500, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 822.9, "standard_charge_percentage": 85.0000, "estimated_amount": 822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 968.12, "estimated_amount": 968, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 822.9, "standard_charge_percentage": 85.0000, "estimated_amount": 822, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 184.17, "standard_charge_percentage": 19.0200, "estimated_amount": 184, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 774.5, "standard_charge_percentage": 80.0000, "estimated_amount": 774, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 759.01, "standard_charge_percentage": 78.4000, "estimated_amount": 759, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 774.5, "standard_charge_percentage": 80.0000, "estimated_amount": 774, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 484.06, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 759.01, "standard_charge_percentage": 78.4000, "estimated_amount": 759, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Temporomandibl Disloc Complic", "code_information": [ { "code": "21485", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6907.7, "discounted_cash": 2267,"minimum": 1288.29,"maximum": 5871.55,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 5871.55, "standard_charge_percentage": 85.0000, "estimated_amount": 5871, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5526.16, "standard_charge_percentage": 80.0000, "estimated_amount": 5526, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5415.64, "standard_charge_percentage": 78.4000, "estimated_amount": 5415, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3002.18, "estimated_amount": 3002, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3488.88, "estimated_amount": 3488, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1352.53, "standard_charge_percentage": 19.5800, "estimated_amount": 1352, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5526.16, "standard_charge_percentage": 80.0000, "estimated_amount": 5526, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2354.99, "estimated_amount": 2354, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2563.45, "estimated_amount": 2563, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3698.21, "estimated_amount": 3698, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3698.21, "estimated_amount": 3698, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1288.29, "standard_charge_percentage": 18.6500, "estimated_amount": 1288, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 5871.55, "standard_charge_percentage": 85.0000, "estimated_amount": 5871, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1314.05, "standard_charge_percentage": 19.0200, "estimated_amount": 1314, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5415.64, "standard_charge_percentage": 78.4000, "estimated_amount": 5415, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3002.18, "estimated_amount": 3002, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3453.85, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3453, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2072.31, "standard_charge_percentage": 30.0000, "estimated_amount": 2072, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1395.55, "estimated_amount": 1395, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3002.18, "estimated_amount": 3002, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 2791.1, "estimated_amount": 2791, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2442.22, "estimated_amount": 2442, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3488.88, "estimated_amount": 3488, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1831.66, "estimated_amount": 1831, "methodology": "fee schedule" }]}]} , { "description": "Hc Biopsy Soft Tissue Neck/Chest", "code_information": [ { "code": "21550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6863, "discounted_cash": 2480,"minimum": 1279.95,"maximum": 5490.4,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5490.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2058.9, "standard_charge_percentage": 30.0000, "estimated_amount": 2058, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3431.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3431, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1305.55, "standard_charge_percentage": 19.0200, "estimated_amount": 1305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1343.78, "standard_charge_percentage": 19.5800, "estimated_amount": 1343, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5490.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1279.95, "standard_charge_percentage": 18.6500, "estimated_amount": 1279, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "Exc Neck Les Sc 3 Cm/>", "code_information": [ { "code": "21552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17313.8, "discounted_cash": 4381,"minimum": 1715,"maximum": 13851,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13851, "standard_charge_percentage": 80.0000, "estimated_amount": 13851, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5194.14, "standard_charge_percentage": 30.0000, "estimated_amount": 5194, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3229.02, "standard_charge_percentage": 18.6500, "estimated_amount": 3229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8656.9, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8656, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3293.6, "standard_charge_percentage": 19.0200, "estimated_amount": 3293, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3390.04, "standard_charge_percentage": 19.5800, "estimated_amount": 3390, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13851, "standard_charge_percentage": 80.0000, "estimated_amount": 13851, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" }]}]} , { "description": "Exc neck tum deep 5 cm/>", "code_information": [ { "code": "21554", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19237.5, "discounted_cash": 4381,"minimum": 1715,"maximum": 15390,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5771.25, "standard_charge_percentage": 30.0000, "estimated_amount": 5771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 15390, "standard_charge_percentage": 80.0000, "estimated_amount": 15390, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3587.79, "standard_charge_percentage": 18.6500, "estimated_amount": 3587, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3659.55, "standard_charge_percentage": 19.0200, "estimated_amount": 3659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3766.7, "standard_charge_percentage": 19.5800, "estimated_amount": 3766, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 15390, "standard_charge_percentage": 80.0000, "estimated_amount": 15390, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" }]}]} , { "description": "Exc neck les sc < 3 cm", "code_information": [ { "code": "21555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 2480,"minimum": 1526.47,"maximum": 12312,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" }]}]} , { "description": "Exc neck tum deep < 5 cm", "code_information": [ { "code": "21556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16351.9, "discounted_cash": 4381,"minimum": 1715,"maximum": 13081.5,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3110.62, "standard_charge_percentage": 19.0200, "estimated_amount": 3110, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4905.57, "standard_charge_percentage": 30.0000, "estimated_amount": 4905, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8175.95, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3049.63, "standard_charge_percentage": 18.6500, "estimated_amount": 3049, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13081.5, "standard_charge_percentage": 80.0000, "estimated_amount": 13081, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3201.7, "standard_charge_percentage": 19.5800, "estimated_amount": 3201, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13081.5, "standard_charge_percentage": 80.0000, "estimated_amount": 13081, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" }]}]} , { "description": "Exc Back Les Sc < 3 Cm", "code_information": [ { "code": "21930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 2480,"minimum": 1526.47,"maximum": 12312,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "Exc back les sc 3 cm/>", "code_information": [ { "code": "21931", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18756.6, "discounted_cash": 2480,"minimum": 1526.47,"maximum": 15005.3,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3498.11, "standard_charge_percentage": 18.6500, "estimated_amount": 3498, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 15005.3, "standard_charge_percentage": 80.0000, "estimated_amount": 15005, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3672.54, "standard_charge_percentage": 19.5800, "estimated_amount": 3672, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 15005.3, "standard_charge_percentage": 80.0000, "estimated_amount": 15005, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3568.07, "standard_charge_percentage": 19.0200, "estimated_amount": 3568, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5626.98, "standard_charge_percentage": 30.0000, "estimated_amount": 5626, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "Exc back tum deep < 5 cm", "code_information": [ { "code": "21932", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 4381,"minimum": 1715,"maximum": 12312,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" }]}]} , { "description": "Exc back tum deep 5 cm/>", "code_information": [ { "code": "21933", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16573.8, "discounted_cash": 4381,"minimum": 1715,"maximum": 13259,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3091.01, "standard_charge_percentage": 18.6500, "estimated_amount": 3091, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4972.14, "standard_charge_percentage": 30.0000, "estimated_amount": 4972, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3152.83, "standard_charge_percentage": 19.0200, "estimated_amount": 3152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13259, "standard_charge_percentage": 80.0000, "estimated_amount": 13259, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3245.15, "standard_charge_percentage": 19.5800, "estimated_amount": 3245, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8286.9, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8286, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13259, "standard_charge_percentage": 80.0000, "estimated_amount": 13259, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "22015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25965,"minimum": 1715,"maximum": 20772,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4842.47, "standard_charge_percentage": 18.6500, "estimated_amount": 4842, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7789.5, "standard_charge_percentage": 30.0000, "estimated_amount": 7789, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5083.95, "standard_charge_percentage": 19.5800, "estimated_amount": 5083, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 8999, "standard_charge_percentage": 70.6000,"standard_charge_algorithm": "Not To Exceed $8999", "estimated_amount": 8999, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 6491.25, "standard_charge_percentage": 25.0000, "estimated_amount": 6491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 20772, "standard_charge_percentage": 80.0000, "estimated_amount": 20772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 8999, "standard_charge_percentage": 70.6000,"standard_charge_algorithm": "Not To Exceed $8999", "estimated_amount": 8999, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 20772, "standard_charge_percentage": 80.0000, "estimated_amount": 20772, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 8999, "standard_charge_percentage": 70.6000,"standard_charge_algorithm": "Not To Exceed $8999", "estimated_amount": 8999, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4939.32, "standard_charge_percentage": 19.0200, "estimated_amount": 4939, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Perq Vertebral Augmentation, Thoracic", "code_information": [ { "code": "22513", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28498, "discounted_cash": 10936,"minimum": 5314.88,"maximum": 24223.3,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 24223.3, "standard_charge_percentage": 85.0000, "estimated_amount": 24223, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 24223.3, "standard_charge_percentage": 85.0000, "estimated_amount": 24223, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5421.17, "standard_charge_percentage": 19.0200, "estimated_amount": 5421, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8549.4, "standard_charge_percentage": 30.0000, "estimated_amount": 8549, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5579.91, "standard_charge_percentage": 19.5800, "estimated_amount": 5579, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 22342.4, "standard_charge_percentage": 78.4000, "estimated_amount": 22342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 22342.4, "standard_charge_percentage": 78.4000, "estimated_amount": 22342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5314.88, "standard_charge_percentage": 18.6500, "estimated_amount": 5314, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 22798.4, "standard_charge_percentage": 80.0000, "estimated_amount": 22798, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 22798.4, "standard_charge_percentage": 80.0000, "estimated_amount": 22798, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" }]}]} , { "description": "Hc Perq Vertebral Augmentation, Lumbar", "code_information": [ { "code": "22514", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28498, "discounted_cash": 10936,"minimum": 5314.88,"maximum": 24223.3,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8549.4, "standard_charge_percentage": 30.0000, "estimated_amount": 8549, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 22342.4, "standard_charge_percentage": 78.4000, "estimated_amount": 22342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 22342.4, "standard_charge_percentage": 78.4000, "estimated_amount": 22342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 24223.3, "standard_charge_percentage": 85.0000, "estimated_amount": 24223, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 24223.3, "standard_charge_percentage": 85.0000, "estimated_amount": 24223, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 22798.4, "standard_charge_percentage": 80.0000, "estimated_amount": 22798, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5314.88, "standard_charge_percentage": 18.6500, "estimated_amount": 5314, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 22798.4, "standard_charge_percentage": 80.0000, "estimated_amount": 22798, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5421.17, "standard_charge_percentage": 19.0200, "estimated_amount": 5421, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5579.91, "standard_charge_percentage": 19.5800, "estimated_amount": 5579, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" }]}]} , { "description": "Hc Perq Vertebral Augmentation Add, Thora Or Lumb", "code_information": [ { "code": "22515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9750.44,"minimum": 1818.46,"maximum": 8287.87,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1818.46, "standard_charge_percentage": 18.6500, "estimated_amount": 1818, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 8287.87, "standard_charge_percentage": 85.0000, "estimated_amount": 8287, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1854.83, "standard_charge_percentage": 19.0200, "estimated_amount": 1854, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 7644.34, "standard_charge_percentage": 78.4000, "estimated_amount": 7644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7800.35, "standard_charge_percentage": 80.0000, "estimated_amount": 7800, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4875.22, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4875, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 7644.34, "standard_charge_percentage": 78.4000, "estimated_amount": 7644, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 8287.87, "standard_charge_percentage": 85.0000, "estimated_amount": 8287, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2925.13, "standard_charge_percentage": 30.0000, "estimated_amount": 2925, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1909.14, "standard_charge_percentage": 19.5800, "estimated_amount": 1909, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7800.35, "standard_charge_percentage": 80.0000, "estimated_amount": 7800, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "22551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5536.05, "discounted_cash": 19698,"minimum": 1032.47,"maximum": 5536.05,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5536.05, "estimated_amount": 5536, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4340.26, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4340, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1053.12, "standard_charge_percentage": 19.0200, "estimated_amount": 1053, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5536.05, "estimated_amount": 5536, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5536.05, "estimated_amount": 5536, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5536.05, "estimated_amount": 5536, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2768.03, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2768, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4340.26, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4340, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4428.84, "standard_charge_percentage": 80.0000, "estimated_amount": 4428, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1660.82, "standard_charge_percentage": 30.0000, "estimated_amount": 1660, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 5536.05, "estimated_amount": 5536, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5536.05, "estimated_amount": 5536, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 5536.05, "estimated_amount": 5536, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 5536.05, "estimated_amount": 5536, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 5536.05, "estimated_amount": 5536, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 5536.05, "estimated_amount": 5536, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 5536.05, "estimated_amount": 5536, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 5536.05, "estimated_amount": 5536, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5536.05, "estimated_amount": 5536, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1032.47, "standard_charge_percentage": 18.6500, "estimated_amount": 1032, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4428.84, "standard_charge_percentage": 80.0000, "estimated_amount": 4428, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 5536.05, "estimated_amount": 5536, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5536.05, "estimated_amount": 5536, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5536.05, "estimated_amount": 5536, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5536.05, "estimated_amount": 5536, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 5536.05, "estimated_amount": 5536, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1083.96, "standard_charge_percentage": 19.5800, "estimated_amount": 1083, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 5536.05, "estimated_amount": 5536, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 5536.05, "estimated_amount": 5536, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5536.05, "estimated_amount": 5536, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5536.05, "estimated_amount": 5536, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 5536.05, "estimated_amount": 5536, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 5536.05, "estimated_amount": 5536, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 5536.05, "estimated_amount": 5536, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "22552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5705.47,"minimum": 1064.07,"maximum": 5667,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1117.13, "standard_charge_percentage": 19.5800, "estimated_amount": 1117, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2852.74, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2852, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1064.07, "standard_charge_percentage": 18.6500, "estimated_amount": 1064, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1085.35, "standard_charge_percentage": 19.0200, "estimated_amount": 1085, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1711.64, "standard_charge_percentage": 30.0000, "estimated_amount": 1711, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5667, "estimated_amount": 5667, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4473.09, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4473, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4473.09, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4473, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4564.38, "standard_charge_percentage": 80.0000, "estimated_amount": 4564, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4564.38, "standard_charge_percentage": 80.0000, "estimated_amount": 4564, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "22600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5643.95,"minimum": 1052.6,"maximum": 5643.95,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5643.95, "estimated_amount": 5643, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4424.86, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4424, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1052.6, "standard_charge_percentage": 18.6500, "estimated_amount": 1052, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5643.95, "estimated_amount": 5643, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3984.63, "standard_charge_percentage": 70.6000,"standard_charge_algorithm": "Not To Exceed $8999", "estimated_amount": 3984, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3984.63, "standard_charge_percentage": 70.6000,"standard_charge_algorithm": "Not To Exceed $8999", "estimated_amount": 3984, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1410.99, "standard_charge_percentage": 25.0000, "estimated_amount": 1410, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4515.16, "standard_charge_percentage": 80.0000, "estimated_amount": 4515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1105.09, "standard_charge_percentage": 19.5800, "estimated_amount": 1105, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3984.63, "standard_charge_percentage": 70.6000,"standard_charge_algorithm": "Not To Exceed $8999", "estimated_amount": 3984, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2821.97, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4424.86, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4424, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1073.65, "standard_charge_percentage": 19.0200, "estimated_amount": 1073, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1693.18, "standard_charge_percentage": 30.0000, "estimated_amount": 1693, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4515.16, "standard_charge_percentage": 80.0000, "estimated_amount": 4515, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "22612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4966.75, "discounted_cash": 28154,"minimum": 926.3,"maximum": 4966.75,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2483.38, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3893.93, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3893, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 926.3, "standard_charge_percentage": 18.6500, "estimated_amount": 926, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 944.82, "standard_charge_percentage": 19.0200, "estimated_amount": 944, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 972.49, "standard_charge_percentage": 19.5800, "estimated_amount": 972, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3973.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3973, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 4966.75, "estimated_amount": 4966, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 4966.75, "estimated_amount": 4966, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4966.75, "estimated_amount": 4966, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3893.93, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3893, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 4966.75, "estimated_amount": 4966, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 4966.75, "estimated_amount": 4966, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 4966.75, "estimated_amount": 4966, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4966.75, "estimated_amount": 4966, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4966.75, "estimated_amount": 4966, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 4966.75, "estimated_amount": 4966, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 4966.75, "estimated_amount": 4966, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4966.75, "estimated_amount": 4966, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4966.75, "estimated_amount": 4966, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1490.03, "standard_charge_percentage": 30.0000, "estimated_amount": 1490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 4966.75, "estimated_amount": 4966, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 4966.75, "estimated_amount": 4966, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 4966.75, "estimated_amount": 4966, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4966.75, "estimated_amount": 4966, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 4966.75, "estimated_amount": 4966, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4966.75, "estimated_amount": 4966, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3973.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3973, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 4966.75, "estimated_amount": 4966, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4966.75, "estimated_amount": 4966, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 4966.75, "estimated_amount": 4966, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 4966.75, "estimated_amount": 4966, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 4966.75, "estimated_amount": 4966, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4966.75, "estimated_amount": 4966, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4966.75, "estimated_amount": 4966, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "22614", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4420.29,"minimum": 824.38,"maximum": 3536.23,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 824.38, "standard_charge_percentage": 18.6500, "estimated_amount": 824, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 840.87, "standard_charge_percentage": 19.0200, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3536.23, "standard_charge_percentage": 80.0000, "estimated_amount": 3536, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3465.51, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3465, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3465.51, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3465, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1326.09, "standard_charge_percentage": 30.0000, "estimated_amount": 1326, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3536.23, "standard_charge_percentage": 80.0000, "estimated_amount": 3536, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2210.14, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2210, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 865.49, "standard_charge_percentage": 19.5800, "estimated_amount": 865, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "22840", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5632.92,"minimum": 1050.54,"maximum": 4506.34,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2816.46, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2816, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4416.21, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4416, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1050.54, "standard_charge_percentage": 18.6500, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4506.34, "standard_charge_percentage": 80.0000, "estimated_amount": 4506, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4416.21, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4416, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1071.55, "standard_charge_percentage": 19.0200, "estimated_amount": 1071, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1689.88, "standard_charge_percentage": 30.0000, "estimated_amount": 1689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1102.93, "standard_charge_percentage": 19.5800, "estimated_amount": 1102, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4506.34, "standard_charge_percentage": 80.0000, "estimated_amount": 4506, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "22842", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4772.05,"minimum": 889.99,"maximum": 3817.64,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3741.29, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3741, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3817.64, "standard_charge_percentage": 80.0000, "estimated_amount": 3817, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 934.37, "standard_charge_percentage": 19.5800, "estimated_amount": 934, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3741.29, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3741, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 907.79, "standard_charge_percentage": 19.0200, "estimated_amount": 907, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1431.62, "standard_charge_percentage": 30.0000, "estimated_amount": 1431, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3817.64, "standard_charge_percentage": 80.0000, "estimated_amount": 3817, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2386.03, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2386, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 889.99, "standard_charge_percentage": 18.6500, "estimated_amount": 889, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "22845", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4679.65,"minimum": 872.75,"maximum": 4679.65,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3668.85, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3668, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 890.21, "standard_charge_percentage": 19.0200, "estimated_amount": 890, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3743.72, "standard_charge_percentage": 80.0000, "estimated_amount": 3743, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4679.65, "estimated_amount": 4679, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1403.89, "standard_charge_percentage": 30.0000, "estimated_amount": 1403, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 916.28, "standard_charge_percentage": 19.5800, "estimated_amount": 916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3743.72, "standard_charge_percentage": 80.0000, "estimated_amount": 3743, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2339.82, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2339, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 872.75, "standard_charge_percentage": 18.6500, "estimated_amount": 872, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4679.65, "estimated_amount": 4679, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3668.85, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3668, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "22846", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9007.65,"minimum": 1679.93,"maximum": 7206.12,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4503.82, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4503, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7206.12, "standard_charge_percentage": 80.0000, "estimated_amount": 7206, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6359.4, "standard_charge_percentage": 70.6000,"standard_charge_algorithm": "Not To Exceed $8999", "estimated_amount": 6359, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2251.91, "standard_charge_percentage": 25.0000, "estimated_amount": 2251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1763.7, "standard_charge_percentage": 19.5800, "estimated_amount": 1763, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1713.53, "standard_charge_percentage": 19.0200, "estimated_amount": 1713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6359.4, "standard_charge_percentage": 70.6000,"standard_charge_algorithm": "Not To Exceed $8999", "estimated_amount": 6359, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6359.4, "standard_charge_percentage": 70.6000,"standard_charge_algorithm": "Not To Exceed $8999", "estimated_amount": 6359, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1679.93, "standard_charge_percentage": 18.6500, "estimated_amount": 1679, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2702.3, "standard_charge_percentage": 30.0000, "estimated_amount": 2702, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7206.12, "standard_charge_percentage": 80.0000, "estimated_amount": 7206, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "22853", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5114.32,"minimum": 953.82,"maximum": 4091.46,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1534.3, "standard_charge_percentage": 30.0000, "estimated_amount": 1534, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1001.38, "standard_charge_percentage": 19.5800, "estimated_amount": 1001, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 972.9, "standard_charge_percentage": 19.0200, "estimated_amount": 972, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4091.46, "standard_charge_percentage": 80.0000, "estimated_amount": 4091, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2557.16, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2557, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4009.63, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4009, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4091.46, "standard_charge_percentage": 80.0000, "estimated_amount": 4091, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4009.63, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4009, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 953.82, "standard_charge_percentage": 18.6500, "estimated_amount": 953, "methodology": "percent of total billed charges" }]}]} , { "description": "Tot Disc Arthrp 1Ntrspc Crv", "code_information": [ { "code": "22856", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34083, "discounted_cash": 28154,"minimum": 1715,"maximum": 34083,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 6673.45, "standard_charge_percentage": 19.5800, "estimated_amount": 6673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 27266.4, "standard_charge_percentage": 80.0000, "estimated_amount": 27266, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 34083, "estimated_amount": 34083, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 30320.1, "estimated_amount": 30320, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 34083, "estimated_amount": 34083, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 34083, "estimated_amount": 34083, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 31825.3, "estimated_amount": 31825, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 34083, "estimated_amount": 34083, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 34083, "estimated_amount": 34083, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 27266.4, "standard_charge_percentage": 80.0000, "estimated_amount": 27266, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 10224.9, "standard_charge_percentage": 30.0000, "estimated_amount": 10224, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 34083, "estimated_amount": 34083, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 34083, "estimated_amount": 34083, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 34083, "estimated_amount": 34083, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 29237.3, "estimated_amount": 29237, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 17325.8, "estimated_amount": 17325, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 22740.1, "estimated_amount": 22740, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 6356.48, "standard_charge_percentage": 18.6500, "estimated_amount": 6356, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 6483.61, "standard_charge_percentage": 19.0200, "estimated_amount": 6483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "22859", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5432.13,"minimum": 1013.09,"maximum": 4345.7,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1033.35, "standard_charge_percentage": 19.0200, "estimated_amount": 1033, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4345.7, "standard_charge_percentage": 80.0000, "estimated_amount": 4345, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2716.07, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2716, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4258.79, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4345.7, "standard_charge_percentage": 80.0000, "estimated_amount": 4345, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4258.79, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1013.09, "standard_charge_percentage": 18.6500, "estimated_amount": 1013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1629.64, "standard_charge_percentage": 30.0000, "estimated_amount": 1629, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1063.61, "standard_charge_percentage": 19.5800, "estimated_amount": 1063, "methodology": "percent of total billed charges" }]}]} , { "description": "Exc abdl tum deep < 5 cm", "code_information": [ { "code": "22900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19237.5, "discounted_cash": 4381,"minimum": 1715,"maximum": 15390,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3587.79, "standard_charge_percentage": 18.6500, "estimated_amount": 3587, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3766.7, "standard_charge_percentage": 19.5800, "estimated_amount": 3766, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3659.55, "standard_charge_percentage": 19.0200, "estimated_amount": 3659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 15390, "standard_charge_percentage": 80.0000, "estimated_amount": 15390, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5771.25, "standard_charge_percentage": 30.0000, "estimated_amount": 5771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 15390, "standard_charge_percentage": 80.0000, "estimated_amount": 15390, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" }]}]} , { "description": "Exc abdl tum deep 5 cm/>", "code_information": [ { "code": "22901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24367.5, "discounted_cash": 4381,"minimum": 1715,"maximum": 19494,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 19494, "standard_charge_percentage": 80.0000, "estimated_amount": 19494, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7310.25, "standard_charge_percentage": 30.0000, "estimated_amount": 7310, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4635.43, "standard_charge_percentage": 19.0200, "estimated_amount": 4635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 19494, "standard_charge_percentage": 80.0000, "estimated_amount": 19494, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4544.54, "standard_charge_percentage": 18.6500, "estimated_amount": 4544, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4771.16, "standard_charge_percentage": 19.5800, "estimated_amount": 4771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" }]}]} , { "description": "Exc abd les sc < 3 cm", "code_information": [ { "code": "22902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19237.5, "discounted_cash": 2480,"minimum": 1526.47,"maximum": 15390,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5771.25, "standard_charge_percentage": 30.0000, "estimated_amount": 5771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3766.7, "standard_charge_percentage": 19.5800, "estimated_amount": 3766, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3659.55, "standard_charge_percentage": 19.0200, "estimated_amount": 3659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 15390, "standard_charge_percentage": 80.0000, "estimated_amount": 15390, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 15390, "standard_charge_percentage": 80.0000, "estimated_amount": 15390, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3587.79, "standard_charge_percentage": 18.6500, "estimated_amount": 3587, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "Exc abd les sc 3 cm/>", "code_information": [ { "code": "22903", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 4381,"minimum": 1715,"maximum": 12312,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "22999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10260, "discounted_cash": 367,"minimum": 225.99,"maximum": 8208,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1913.49, "standard_charge_percentage": 18.6500, "estimated_amount": 1913, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3078, "standard_charge_percentage": 30.0000, "estimated_amount": 3078, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5130, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1951.76, "standard_charge_percentage": 19.0200, "estimated_amount": 1951, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8208, "standard_charge_percentage": 80.0000, "estimated_amount": 8208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2008.91, "standard_charge_percentage": 19.5800, "estimated_amount": 2008, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8208, "standard_charge_percentage": 80.0000, "estimated_amount": 8208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Exc Shoulder Les Sc 3 Cm/>", "code_information": [ { "code": "23071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17313.8, "discounted_cash": 2480,"minimum": 1526.47,"maximum": 13851,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13851, "standard_charge_percentage": 80.0000, "estimated_amount": 13851, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5194.14, "standard_charge_percentage": 30.0000, "estimated_amount": 5194, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3229.02, "standard_charge_percentage": 18.6500, "estimated_amount": 3229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8656.9, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8656, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3293.6, "standard_charge_percentage": 19.0200, "estimated_amount": 3293, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3390.04, "standard_charge_percentage": 19.5800, "estimated_amount": 3390, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13851, "standard_charge_percentage": 80.0000, "estimated_amount": 13851, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" }]}]} , { "description": "Exc Shoulder Tum Deep 5 Cm/>", "code_information": [ { "code": "23073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23085, "discounted_cash": 4381,"minimum": 1715,"maximum": 18468,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4391.46, "standard_charge_percentage": 19.0200, "estimated_amount": 4391, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 18468, "standard_charge_percentage": 80.0000, "estimated_amount": 18468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4305.35, "standard_charge_percentage": 18.6500, "estimated_amount": 4305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 18468, "standard_charge_percentage": 80.0000, "estimated_amount": 18468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6925.5, "standard_charge_percentage": 30.0000, "estimated_amount": 6925, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4520.04, "standard_charge_percentage": 19.5800, "estimated_amount": 4520, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" }]}]} , { "description": "Exc shoulder les sc < 3 cm", "code_information": [ { "code": "23075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 2480,"minimum": 1526.47,"maximum": 12312,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" }]}]} , { "description": "Exc Shoulder Tum Deep < 5 Cm", "code_information": [ { "code": "23076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23085, "discounted_cash": 4381,"minimum": 1715,"maximum": 18468,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4391.46, "standard_charge_percentage": 19.0200, "estimated_amount": 4391, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4520.04, "standard_charge_percentage": 19.5800, "estimated_amount": 4520, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4305.35, "standard_charge_percentage": 18.6500, "estimated_amount": 4305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 18468, "standard_charge_percentage": 80.0000, "estimated_amount": 18468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 18468, "standard_charge_percentage": 80.0000, "estimated_amount": 18468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6925.5, "standard_charge_percentage": 30.0000, "estimated_amount": 6925, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "23120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35706.7, "discounted_cash": 4967,"minimum": 1715,"maximum": 28565.3,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 28565.3, "standard_charge_percentage": 80.0000, "estimated_amount": 28565, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 6659.29, "standard_charge_percentage": 18.6500, "estimated_amount": 6659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 10712, "standard_charge_percentage": 30.0000, "estimated_amount": 10712, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 6792.48, "standard_charge_percentage": 19.0200, "estimated_amount": 6792, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 28565.3, "standard_charge_percentage": 80.0000, "estimated_amount": 28565, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 6991.37, "standard_charge_percentage": 19.5800, "estimated_amount": 6991, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "23130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15988.3, "discounted_cash": 4967,"minimum": 1715,"maximum": 12790.7,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3041.46, "standard_charge_percentage": 19.0200, "estimated_amount": 3041, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12790.7, "standard_charge_percentage": 80.0000, "estimated_amount": 12790, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5667, "estimated_amount": 5667, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4796.5, "standard_charge_percentage": 30.0000, "estimated_amount": 4796, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3130.52, "standard_charge_percentage": 19.5800, "estimated_amount": 3130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7994.16, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7994, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2981.82, "standard_charge_percentage": 18.6500, "estimated_amount": 2981, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12790.7, "standard_charge_percentage": 80.0000, "estimated_amount": 12790, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Removal of bone lesion", "code_information": [ { "code": "23140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30780, "discounted_cash": 4967,"minimum": 1715,"maximum": 24624,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5855.28, "standard_charge_percentage": 19.0200, "estimated_amount": 5855, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 24624, "standard_charge_percentage": 80.0000, "estimated_amount": 24624, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 9234, "standard_charge_percentage": 30.0000, "estimated_amount": 9234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 6026.72, "standard_charge_percentage": 19.5800, "estimated_amount": 6026, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5740.47, "standard_charge_percentage": 18.6500, "estimated_amount": 5740, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 24624, "standard_charge_percentage": 80.0000, "estimated_amount": 24624, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" }]}]} , { "description": "Remove Shoulder Fb Deep", "code_information": [ { "code": "23333", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 4381,"minimum": 1715,"maximum": 12312,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" }]}]} , { "description": "Hc Inj Proc Shoulder Arthrography/Ct/Mri", "code_information": [ { "code": "23350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1388.33,"minimum": 258.92,"maximum": 1388.33,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1088.45, "standard_charge_percentage": 78.4000, "estimated_amount": 1088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 694.16, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1110.66, "standard_charge_percentage": 80.0000, "estimated_amount": 1110, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 271.84, "standard_charge_percentage": 19.5800, "estimated_amount": 271, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1388.33, "estimated_amount": 1388, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1388.33, "estimated_amount": 1388, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 258.92, "standard_charge_percentage": 18.6500, "estimated_amount": 258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1180.08, "standard_charge_percentage": 85.0000, "estimated_amount": 1180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1180.08, "standard_charge_percentage": 85.0000, "estimated_amount": 1180, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 264.1, "standard_charge_percentage": 19.0200, "estimated_amount": 264, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 416.5, "standard_charge_percentage": 30.0000, "estimated_amount": 416, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1088.45, "standard_charge_percentage": 78.4000, "estimated_amount": 1088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1110.66, "standard_charge_percentage": 80.0000, "estimated_amount": 1110, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "23410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18645.4, "discounted_cash": 10936,"minimum": 1715,"maximum": 17835.3,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3546.91, "standard_charge_percentage": 19.0200, "estimated_amount": 3546, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3650.77, "standard_charge_percentage": 19.5800, "estimated_amount": 3650, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5667, "estimated_amount": 5667, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3477.37, "standard_charge_percentage": 18.6500, "estimated_amount": 3477, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 14916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 14916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5593.62, "standard_charge_percentage": 30.0000, "estimated_amount": 5593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "23412", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40169.3, "discounted_cash": 10936,"minimum": 1715,"maximum": 32135.4,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32135.4, "standard_charge_percentage": 80.0000, "estimated_amount": 32135, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 7641.4, "standard_charge_percentage": 19.0200, "estimated_amount": 7641, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 7865.14, "standard_charge_percentage": 19.5800, "estimated_amount": 7865, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5667, "estimated_amount": 5667, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 7491.57, "standard_charge_percentage": 18.6500, "estimated_amount": 7491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32135.4, "standard_charge_percentage": 80.0000, "estimated_amount": 32135, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12050.8, "standard_charge_percentage": 30.0000, "estimated_amount": 12050, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "23430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25442.7, "discounted_cash": 10936,"minimum": 1715,"maximum": 20354.2,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4745.07, "standard_charge_percentage": 18.6500, "estimated_amount": 4745, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4839.97, "standard_charge_percentage": 19.0200, "estimated_amount": 4839, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4981.68, "standard_charge_percentage": 19.5800, "estimated_amount": 4981, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 20354.2, "standard_charge_percentage": 80.0000, "estimated_amount": 20354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5667, "estimated_amount": 5667, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 20354.2, "standard_charge_percentage": 80.0000, "estimated_amount": 20354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7632.82, "standard_charge_percentage": 30.0000, "estimated_amount": 7632, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "23462", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 49045, "discounted_cash": 10936,"minimum": 1715,"maximum": 39236,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 9329.83, "standard_charge_percentage": 19.0200, "estimated_amount": 9329, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 9603.01, "standard_charge_percentage": 19.5800, "estimated_amount": 9603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 14713.5, "standard_charge_percentage": 30.0000, "estimated_amount": 14713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5667, "estimated_amount": 5667, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 9146.89, "standard_charge_percentage": 18.6500, "estimated_amount": 9146, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 39236, "standard_charge_percentage": 80.0000, "estimated_amount": 39236, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 39236, "standard_charge_percentage": 80.0000, "estimated_amount": 39236, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" }]}]} , { "description": "Reconstruct Shoulder Joint", "code_information": [ { "code": "23472", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65819.5, "discounted_cash": 28154,"minimum": 1715,"maximum": 52655.6,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 52655.6, "standard_charge_percentage": 80.0000, "estimated_amount": 52655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 52655.6, "standard_charge_percentage": 80.0000, "estimated_amount": 52655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 34651.6, "estimated_amount": 34651, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 45913.3, "estimated_amount": 45913, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 7566, "estimated_amount": 7566, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 12887.5, "standard_charge_percentage": 19.5800, "estimated_amount": 12887, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 37272.1, "estimated_amount": 37272, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 22740.1, "estimated_amount": 22740, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 45913.3, "estimated_amount": 45913, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 12275.3, "standard_charge_percentage": 18.6500, "estimated_amount": 12275, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 12520.8, "standard_charge_percentage": 19.0200, "estimated_amount": 12520, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 19745.8, "standard_charge_percentage": 30.0000, "estimated_amount": 19745, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 17325.8, "estimated_amount": 17325, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 37272.1, "estimated_amount": 37272, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 43314.4, "estimated_amount": 43314, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 29237.3, "estimated_amount": 29237, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 37272.1, "estimated_amount": 37272, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 30320.1, "estimated_amount": 30320, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 43314.4, "estimated_amount": 43314, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 31825.3, "estimated_amount": 31825, "methodology": "fee schedule" }]}]} , { "description": "CLTX CLAVICULAR FX WO MNPJ", "code_information": [ { "code": "23500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Optx clavicular fx w/int fix", "code_information": [ { "code": "23515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64272, "discounted_cash": 10936,"minimum": 1715,"maximum": 51417.6,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 51417.6, "standard_charge_percentage": 80.0000, "estimated_amount": 51417, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 11986.7, "standard_charge_percentage": 18.6500, "estimated_amount": 11986, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 12226.5, "standard_charge_percentage": 19.0200, "estimated_amount": 12226, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 51417.6, "standard_charge_percentage": 80.0000, "estimated_amount": 51417, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 12584.5, "standard_charge_percentage": 19.5800, "estimated_amount": 12584, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 19281.6, "standard_charge_percentage": 30.0000, "estimated_amount": 19281, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat A-C Jt Disloc Wo Manip", "code_information": [ { "code": "23540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Optx Acromclv Dislc Aqt/Chrn", "code_information": [ { "code": "23550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34083, "discounted_cash": 10936,"minimum": 1715,"maximum": 27266.4,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 6356.48, "standard_charge_percentage": 18.6500, "estimated_amount": 6356, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 6483.61, "standard_charge_percentage": 19.0200, "estimated_amount": 6483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 6673.45, "standard_charge_percentage": 19.5800, "estimated_amount": 6673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 27266.4, "standard_charge_percentage": 80.0000, "estimated_amount": 27266, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 10224.9, "standard_charge_percentage": 30.0000, "estimated_amount": 10224, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 27266.4, "standard_charge_percentage": 80.0000, "estimated_amount": 27266, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "23552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6816.6, "discounted_cash": 10936,"minimum": 1271.3,"maximum": 6816.6,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 6816.6, "estimated_amount": 6816, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 6816.6, "estimated_amount": 6816, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6816.6, "estimated_amount": 6816, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6816.6, "estimated_amount": 6816, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6816.6, "estimated_amount": 6816, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6816.6, "estimated_amount": 6816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 6816.6, "estimated_amount": 6816, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 6816.6, "estimated_amount": 6816, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 6816.6, "estimated_amount": 6816, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 6816.6, "estimated_amount": 6816, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1334.69, "standard_charge_percentage": 19.5800, "estimated_amount": 1334, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 6816.6, "estimated_amount": 6816, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 6816.6, "estimated_amount": 6816, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6816.6, "estimated_amount": 6816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 6816.6, "estimated_amount": 6816, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 6816.6, "estimated_amount": 6816, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3408.3, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3408, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2044.98, "standard_charge_percentage": 30.0000, "estimated_amount": 2044, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6816.6, "estimated_amount": 6816, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6816.6, "estimated_amount": 6816, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 6816.6, "estimated_amount": 6816, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 6816.6, "estimated_amount": 6816, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1271.3, "standard_charge_percentage": 18.6500, "estimated_amount": 1271, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1296.72, "standard_charge_percentage": 19.0200, "estimated_amount": 1296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5453.28, "standard_charge_percentage": 80.0000, "estimated_amount": 5453, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5453.28, "standard_charge_percentage": 80.0000, "estimated_amount": 5453, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6816.6, "estimated_amount": 6816, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 6816.6, "estimated_amount": 6816, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 6816.6, "estimated_amount": 6816, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Prox Humerus Fx Wo Manip", "code_information": [ { "code": "23600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Gr Tuber Hum Fx W Manip", "code_information": [ { "code": "23625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4895.38, "discounted_cash": 2450,"minimum": 912.99,"maximum": 4161.07,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2447.69, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2447, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 912.99, "standard_charge_percentage": 18.6500, "estimated_amount": 912, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 958.52, "standard_charge_percentage": 19.5800, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 4161.07, "standard_charge_percentage": 85.0000, "estimated_amount": 4161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 4161.07, "standard_charge_percentage": 85.0000, "estimated_amount": 4161, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 931.25, "standard_charge_percentage": 19.0200, "estimated_amount": 931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1468.61, "standard_charge_percentage": 30.0000, "estimated_amount": 1468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Shldr Disloc W Manip Wo Anes", "code_information": [ { "code": "23650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 968.12, "discounted_cash": 367,"minimum": 180.55,"maximum": 968.12,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 184.17, "standard_charge_percentage": 19.0200, "estimated_amount": 184, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 774.5, "standard_charge_percentage": 80.0000, "estimated_amount": 774, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 290.44, "standard_charge_percentage": 30.0000, "estimated_amount": 290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 968.12, "estimated_amount": 968, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 484.06, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 180.55, "standard_charge_percentage": 18.6500, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 822.9, "standard_charge_percentage": 85.0000, "estimated_amount": 822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 759.01, "standard_charge_percentage": 78.4000, "estimated_amount": 759, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 759.01, "standard_charge_percentage": 78.4000, "estimated_amount": 759, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 774.5, "standard_charge_percentage": 80.0000, "estimated_amount": 774, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 968.12, "estimated_amount": 968, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 822.9, "standard_charge_percentage": 85.0000, "estimated_amount": 822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 189.56, "standard_charge_percentage": 19.5800, "estimated_amount": 189, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Shldr Disloc W Manip W Anes", "code_information": [ { "code": "23655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4895.38, "discounted_cash": 2450,"minimum": 912.99,"maximum": 4161.07,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1468.61, "standard_charge_percentage": 30.0000, "estimated_amount": 1468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2447.69, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2447, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 931.25, "standard_charge_percentage": 19.0200, "estimated_amount": 931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 4161.07, "standard_charge_percentage": 85.0000, "estimated_amount": 4161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 4161.07, "standard_charge_percentage": 85.0000, "estimated_amount": 4161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 958.52, "standard_charge_percentage": 19.5800, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 912.99, "standard_charge_percentage": 18.6500, "estimated_amount": 912, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Shldr Disloc,Gr Tub Fx, W Manip", "code_information": [ { "code": "23665", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4895.38, "discounted_cash": 2450,"minimum": 912.99,"maximum": 4161.07,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1468.61, "standard_charge_percentage": 30.0000, "estimated_amount": 1468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2447.69, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2447, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 958.52, "standard_charge_percentage": 19.5800, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 4161.07, "standard_charge_percentage": 85.0000, "estimated_amount": 4161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 4161.07, "standard_charge_percentage": 85.0000, "estimated_amount": 4161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 912.99, "standard_charge_percentage": 18.6500, "estimated_amount": 912, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 931.25, "standard_charge_percentage": 19.0200, "estimated_amount": 931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Shldr Disloc,Prox Hum Fx W Manip", "code_information": [ { "code": "23675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7172.6, "discounted_cash": 2450,"minimum": 1337.69,"maximum": 12312,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1364.44, "standard_charge_percentage": 19.0200, "estimated_amount": 1364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3586.3, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3586, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1337.69, "standard_charge_percentage": 18.6500, "estimated_amount": 1337, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1404.4, "standard_charge_percentage": 19.5800, "estimated_amount": 1404, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5623.32, "standard_charge_percentage": 78.4000, "estimated_amount": 5623, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5738.08, "standard_charge_percentage": 80.0000, "estimated_amount": 5738, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 6096.71, "standard_charge_percentage": 85.0000, "estimated_amount": 6096, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5738.08, "standard_charge_percentage": 80.0000, "estimated_amount": 5738, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5623.32, "standard_charge_percentage": 78.4000, "estimated_amount": 5623, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 6096.71, "standard_charge_percentage": 85.0000, "estimated_amount": 6096, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2151.78, "standard_charge_percentage": 30.0000, "estimated_amount": 2151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" }]}]} , { "description": "Hc I&D Arm/Elbow Infect Bursa", "code_information": [ { "code": "23931", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5127.07, "discounted_cash": 2480,"minimum": 956.2,"maximum": 4101.66,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4019.62, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4019, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 956.2, "standard_charge_percentage": 18.6500, "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 975.32, "standard_charge_percentage": 19.0200, "estimated_amount": 975, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4101.66, "standard_charge_percentage": 80.0000, "estimated_amount": 4101, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1003.88, "standard_charge_percentage": 19.5800, "estimated_amount": 1003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2563.53, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2563, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4019.62, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4019, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1538.12, "standard_charge_percentage": 30.0000, "estimated_amount": 1538, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4101.66, "standard_charge_percentage": 80.0000, "estimated_amount": 4101, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "24071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5795.3, "discounted_cash": 4381,"minimum": 1080.82,"maximum": 5795.3,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4636.24, "standard_charge_percentage": 80.0000, "estimated_amount": 4636, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5795.3, "estimated_amount": 5795, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5795.3, "estimated_amount": 5795, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4543.52, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4543, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1080.82, "standard_charge_percentage": 18.6500, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 5795.3, "estimated_amount": 5795, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 5795.3, "estimated_amount": 5795, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4543.52, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4543, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1102.44, "standard_charge_percentage": 19.0200, "estimated_amount": 1102, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1738.59, "standard_charge_percentage": 30.0000, "estimated_amount": 1738, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4636.24, "standard_charge_percentage": 80.0000, "estimated_amount": 4636, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5795.3, "estimated_amount": 5795, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2897.65, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2897, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1134.72, "standard_charge_percentage": 19.5800, "estimated_amount": 1134, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5795.3, "estimated_amount": 5795, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 5795.3, "estimated_amount": 5795, "methodology": "fee schedule" }]}]} , { "description": "Ex Arm/Elbow Tum Deep 5 Cm/>", "code_information": [ { "code": "24073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 4381,"minimum": 1715,"maximum": 12312,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "24075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310.25, "discounted_cash": 2480,"minimum": 1363.36,"maximum": 5848.2,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3655.13, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1390.63, "standard_charge_percentage": 19.0200, "estimated_amount": 1390, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5848.2, "standard_charge_percentage": 80.0000, "estimated_amount": 5848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5848.2, "standard_charge_percentage": 80.0000, "estimated_amount": 5848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2193.07, "standard_charge_percentage": 30.0000, "estimated_amount": 2193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1431.35, "standard_charge_percentage": 19.5800, "estimated_amount": 1431, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1363.36, "standard_charge_percentage": 18.6500, "estimated_amount": 1363, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" }]}]} , { "description": "Hc Removal Arm/Elbow Fb Subq", "code_information": [ { "code": "24200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5127.07, "discounted_cash": 2480,"minimum": 956.2,"maximum": 4101.66,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4019.62, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4019, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4101.66, "standard_charge_percentage": 80.0000, "estimated_amount": 4101, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2563.53, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2563, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 975.32, "standard_charge_percentage": 19.0200, "estimated_amount": 975, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4101.66, "standard_charge_percentage": 80.0000, "estimated_amount": 4101, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4019.62, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4019, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 956.2, "standard_charge_percentage": 18.6500, "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1538.12, "standard_charge_percentage": 30.0000, "estimated_amount": 1538, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1003.88, "standard_charge_percentage": 19.5800, "estimated_amount": 1003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "RMVL FB UPPER ARMELBW DEEP", "code_information": [ { "code": "24201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 4381,"minimum": 1715,"maximum": 12312,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "24341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37329.3, "discounted_cash": 10936,"minimum": 1715,"maximum": 29863.5,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 6961.92, "standard_charge_percentage": 18.6500, "estimated_amount": 6961, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 7101.16, "standard_charge_percentage": 19.0200, "estimated_amount": 7101, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 29863.5, "standard_charge_percentage": 80.0000, "estimated_amount": 29863, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 7309.08, "standard_charge_percentage": 19.5800, "estimated_amount": 7309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5667, "estimated_amount": 5667, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 11198.8, "standard_charge_percentage": 30.0000, "estimated_amount": 11198, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 29863.5, "standard_charge_percentage": 80.0000, "estimated_amount": 29863, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" }]}]} , { "description": "Repair Of Ruptured Tendon", "code_information": [ { "code": "24342", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 63297, "discounted_cash": 10936,"minimum": 1715,"maximum": 50637.6,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5667, "estimated_amount": 5667, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 12041, "standard_charge_percentage": 19.0200, "estimated_amount": 12040, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 12393.5, "standard_charge_percentage": 19.5800, "estimated_amount": 12393, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 11804.9, "standard_charge_percentage": 18.6500, "estimated_amount": 11804, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 50637.6, "standard_charge_percentage": 80.0000, "estimated_amount": 50637, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 50637.6, "standard_charge_percentage": 80.0000, "estimated_amount": 50637, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 18989.1, "standard_charge_percentage": 30.0000, "estimated_amount": 18989, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "24343", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10260, "discounted_cash": 4967,"minimum": 1715,"maximum": 8208,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5130, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1913.49, "standard_charge_percentage": 18.6500, "estimated_amount": 1913, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1951.76, "standard_charge_percentage": 19.0200, "estimated_amount": 1951, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8208, "standard_charge_percentage": 80.0000, "estimated_amount": 8208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3078, "standard_charge_percentage": 30.0000, "estimated_amount": 3078, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2008.91, "standard_charge_percentage": 19.5800, "estimated_amount": 2008, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8208, "standard_charge_percentage": 80.0000, "estimated_amount": 8208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Repair elbow deb/attch open", "code_information": [ { "code": "24359", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29119, "discounted_cash": 4967,"minimum": 1715,"maximum": 23295.2,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5430.69, "standard_charge_percentage": 18.6500, "estimated_amount": 5430, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5539.31, "standard_charge_percentage": 19.0200, "estimated_amount": 5539, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 23295.2, "standard_charge_percentage": 80.0000, "estimated_amount": 23295, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 23295.2, "standard_charge_percentage": 80.0000, "estimated_amount": 23295, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5701.5, "standard_charge_percentage": 19.5800, "estimated_amount": 5701, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8735.7, "standard_charge_percentage": 30.0000, "estimated_amount": 8735, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "TREAT HUMERUS FRACTURE", "code_information": [ { "code": "24500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Humeral Supracondylar Fx Wo Manip", "code_information": [ { "code": "24530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Elbow Disloc Wo Anes", "code_information": [ { "code": "24600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 968.12, "discounted_cash": 367,"minimum": 180.55,"maximum": 968.12,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 822.9, "standard_charge_percentage": 85.0000, "estimated_amount": 822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 759.01, "standard_charge_percentage": 78.4000, "estimated_amount": 759, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 759.01, "standard_charge_percentage": 78.4000, "estimated_amount": 759, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 968.12, "estimated_amount": 968, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 774.5, "standard_charge_percentage": 80.0000, "estimated_amount": 774, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 290.44, "standard_charge_percentage": 30.0000, "estimated_amount": 290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 189.56, "standard_charge_percentage": 19.5800, "estimated_amount": 189, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 484.06, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 180.55, "standard_charge_percentage": 18.6500, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 968.12, "estimated_amount": 968, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 822.9, "standard_charge_percentage": 85.0000, "estimated_amount": 822, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 184.17, "standard_charge_percentage": 19.0200, "estimated_amount": 184, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 774.5, "standard_charge_percentage": 80.0000, "estimated_amount": 774, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Elbow Disloc W Anes", "code_information": [ { "code": "24605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4895.38, "discounted_cash": 2450,"minimum": 912.99,"maximum": 4161.07,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 4161.07, "standard_charge_percentage": 85.0000, "estimated_amount": 4161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 4161.07, "standard_charge_percentage": 85.0000, "estimated_amount": 4161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 912.99, "standard_charge_percentage": 18.6500, "estimated_amount": 912, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 958.52, "standard_charge_percentage": 19.5800, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 931.25, "standard_charge_percentage": 19.0200, "estimated_amount": 931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1468.61, "standard_charge_percentage": 30.0000, "estimated_amount": 1468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2447.69, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2447, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Radial Head Disloc Child W Amnip", "code_information": [ { "code": "24640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 968.12, "discounted_cash": 367,"minimum": 180.55,"maximum": 968.12,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 184.17, "standard_charge_percentage": 19.0200, "estimated_amount": 184, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 774.5, "standard_charge_percentage": 80.0000, "estimated_amount": 774, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 484.06, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 180.55, "standard_charge_percentage": 18.6500, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 822.9, "standard_charge_percentage": 85.0000, "estimated_amount": 822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 759.01, "standard_charge_percentage": 78.4000, "estimated_amount": 759, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 759.01, "standard_charge_percentage": 78.4000, "estimated_amount": 759, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 968.12, "estimated_amount": 968, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 968.12, "estimated_amount": 968, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 189.56, "standard_charge_percentage": 19.5800, "estimated_amount": 189, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 774.5, "standard_charge_percentage": 80.0000, "estimated_amount": 774, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 822.9, "standard_charge_percentage": 85.0000, "estimated_amount": 822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 290.44, "standard_charge_percentage": 30.0000, "estimated_amount": 290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Radial Head/Neck Fx Wo Manip", "code_information": [ { "code": "24650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Radial Head/Neck Fx W Manip", "code_information": [ { "code": "24655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4895.38, "discounted_cash": 2450,"minimum": 912.99,"maximum": 4161.07,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 4161.07, "standard_charge_percentage": 85.0000, "estimated_amount": 4161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1468.61, "standard_charge_percentage": 30.0000, "estimated_amount": 1468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2447.69, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2447, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 912.99, "standard_charge_percentage": 18.6500, "estimated_amount": 912, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 931.25, "standard_charge_percentage": 19.0200, "estimated_amount": 931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 4161.07, "standard_charge_percentage": 85.0000, "estimated_amount": 4161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 958.52, "standard_charge_percentage": 19.5800, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" }]}]} , { "description": "Treat Radius Fracture", "code_information": [ { "code": "24666", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34620, "discounted_cash": 19698,"minimum": 1715,"maximum": 32123.8,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 6585.76, "standard_charge_percentage": 19.0200, "estimated_amount": 6585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 6778.6, "standard_charge_percentage": 19.5800, "estimated_amount": 6778, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 26077.8, "estimated_amount": 26077, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 21213.8, "estimated_amount": 21213, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 22266.9, "estimated_amount": 22266, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 6456.63, "standard_charge_percentage": 18.6500, "estimated_amount": 6456, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 12122.2, "estimated_amount": 12122, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 24244.4, "estimated_amount": 24244, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 20456.2, "estimated_amount": 20456, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 26077.8, "estimated_amount": 26077, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 30305.5, "estimated_amount": 30305, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 30305.5, "estimated_amount": 30305, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 27696, "standard_charge_percentage": 80.0000, "estimated_amount": 27696, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 10386, "standard_charge_percentage": 30.0000, "estimated_amount": 10386, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 27696, "standard_charge_percentage": 80.0000, "estimated_amount": 27696, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 26077.8, "estimated_amount": 26077, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 15910.4, "estimated_amount": 15910, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 32123.8, "estimated_amount": 32123, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 32123.8, "estimated_amount": 32123, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Ulnar Xf Prox End Wo Manip", "code_information": [ { "code": "24670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Treat Ulnar Fracture", "code_information": [ { "code": "24685", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40120, "discounted_cash": 10936,"minimum": 1715,"maximum": 32096,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 7632.03, "standard_charge_percentage": 19.0200, "estimated_amount": 7632, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32096, "standard_charge_percentage": 80.0000, "estimated_amount": 32096, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 7855.5, "standard_charge_percentage": 19.5800, "estimated_amount": 7855, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 7482.38, "standard_charge_percentage": 18.6500, "estimated_amount": 7482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32096, "standard_charge_percentage": 80.0000, "estimated_amount": 32096, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12036, "standard_charge_percentage": 30.0000, "estimated_amount": 12036, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" }]}]} , { "description": "Incision of tendon sheath", "code_information": [ { "code": "25000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15437.6, "discounted_cash": 2450,"minimum": 1507.78,"maximum": 12350.1,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12350.1, "standard_charge_percentage": 80.0000, "estimated_amount": 12350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7718.8, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7718, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2879.11, "standard_charge_percentage": 18.6500, "estimated_amount": 2879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3022.68, "standard_charge_percentage": 19.5800, "estimated_amount": 3022, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2936.69, "standard_charge_percentage": 19.0200, "estimated_amount": 2936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4631.28, "standard_charge_percentage": 30.0000, "estimated_amount": 4631, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12350.1, "standard_charge_percentage": 80.0000, "estimated_amount": 12350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "25071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11445.1, "discounted_cash": 2480,"minimum": 1526.47,"maximum": 9156.05,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5722.53, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5722, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9156.05, "standard_charge_percentage": 80.0000, "estimated_amount": 9156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3433.52, "standard_charge_percentage": 30.0000, "estimated_amount": 3433, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2134.5, "standard_charge_percentage": 18.6500, "estimated_amount": 2134, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2177.19, "standard_charge_percentage": 19.0200, "estimated_amount": 2177, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9156.05, "standard_charge_percentage": 80.0000, "estimated_amount": 9156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2240.94, "standard_charge_percentage": 19.5800, "estimated_amount": 2240, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" }]}]} , { "description": "Exc forearm tum deep 3 cm/>", "code_information": [ { "code": "25073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 4381,"minimum": 1715,"maximum": 12312,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" }]}]} , { "description": "Exc Forearm Les Sc < 3 Cm", "code_information": [ { "code": "25075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 2480,"minimum": 1526.47,"maximum": 12312,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "Exc forearm tum deep < 3 cm", "code_information": [ { "code": "25076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 2480,"minimum": 1526.47,"maximum": 12312,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "25110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 2450,"minimum": 1507.78,"maximum": 12312,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" }]}]} , { "description": "Remove wrist tendon lesion", "code_information": [ { "code": "25111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18275.6, "discounted_cash": 2450,"minimum": 1507.78,"maximum": 14620.5,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3476.57, "standard_charge_percentage": 19.0200, "estimated_amount": 3476, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5482.68, "standard_charge_percentage": 30.0000, "estimated_amount": 5482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3578.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14620.5, "standard_charge_percentage": 80.0000, "estimated_amount": 14620, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3408.4, "standard_charge_percentage": 18.6500, "estimated_amount": 3408, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14620.5, "standard_charge_percentage": 80.0000, "estimated_amount": 14620, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "25116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9688, "discounted_cash": 4967,"minimum": 1715,"maximum": 8100.6,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4844, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4844, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1806.81, "standard_charge_percentage": 18.6500, "estimated_amount": 1806, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2906.4, "standard_charge_percentage": 30.0000, "estimated_amount": 2906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7750.4, "standard_charge_percentage": 80.0000, "estimated_amount": 7750, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1896.91, "standard_charge_percentage": 19.5800, "estimated_amount": 1896, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1842.95, "standard_charge_percentage": 19.0200, "estimated_amount": 1842, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7750.4, "standard_charge_percentage": 80.0000, "estimated_amount": 7750, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "25259", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6837, "discounted_cash": 2450,"minimum": 1275.1,"maximum": 5469.6,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2051.1, "standard_charge_percentage": 30.0000, "estimated_amount": 2051, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1300.6, "standard_charge_percentage": 19.0200, "estimated_amount": 1300, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5469.6, "standard_charge_percentage": 80.0000, "estimated_amount": 5469, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1338.68, "standard_charge_percentage": 19.5800, "estimated_amount": 1338, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3418.5, "standard_charge_percentage": 50.0000, "estimated_amount": 3418, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1275.1, "standard_charge_percentage": 18.6500, "estimated_amount": 1275, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5469.6, "standard_charge_percentage": 80.0000, "estimated_amount": 5469, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "25260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8384, "discounted_cash": 4967,"minimum": 1563.62,"maximum": 8100.6,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4192, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4192, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1563.62, "standard_charge_percentage": 18.6500, "estimated_amount": 1563, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6707.2, "standard_charge_percentage": 80.0000, "estimated_amount": 6707, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1641.59, "standard_charge_percentage": 19.5800, "estimated_amount": 1641, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1594.89, "standard_charge_percentage": 19.0200, "estimated_amount": 1594, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2515.2, "standard_charge_percentage": 30.0000, "estimated_amount": 2515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6707.2, "standard_charge_percentage": 80.0000, "estimated_amount": 6707, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "25270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8655, "discounted_cash": 4967,"minimum": 1614.16,"maximum": 8100.6,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1614.16, "standard_charge_percentage": 18.6500, "estimated_amount": 1614, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6924, "standard_charge_percentage": 80.0000, "estimated_amount": 6924, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1646.44, "standard_charge_percentage": 19.0200, "estimated_amount": 1646, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6924, "standard_charge_percentage": 80.0000, "estimated_amount": 6924, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2596.5, "standard_charge_percentage": 30.0000, "estimated_amount": 2596, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4327.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4327, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1694.65, "standard_charge_percentage": 19.5800, "estimated_amount": 1694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "25295", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5771.25, "discounted_cash": 4967,"minimum": 1076.34,"maximum": 5771.25,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4524.66, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4524, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4524.66, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4524, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4617, "standard_charge_percentage": 80.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1731.38, "standard_charge_percentage": 30.0000, "estimated_amount": 1731, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 5771.25, "estimated_amount": 5771, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 5771.25, "estimated_amount": 5771, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1076.34, "standard_charge_percentage": 18.6500, "estimated_amount": 1076, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1130.01, "standard_charge_percentage": 19.5800, "estimated_amount": 1130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5771.25, "estimated_amount": 5771, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5771.25, "estimated_amount": 5771, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 5771.25, "estimated_amount": 5771, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4617, "standard_charge_percentage": 80.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5771.25, "estimated_amount": 5771, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5771.25, "estimated_amount": 5771, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2885.63, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2885, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1097.86, "standard_charge_percentage": 19.0200, "estimated_amount": 1097, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5771.25, "estimated_amount": 5771, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" }]}]} , { "description": "Repair/Revise Wrist Joint", "code_information": [ { "code": "25320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30292.5, "discounted_cash": 10936,"minimum": 1715,"maximum": 24234,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5667, "estimated_amount": 5667, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5762.54, "standard_charge_percentage": 19.0200, "estimated_amount": 5762, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5649.55, "standard_charge_percentage": 18.6500, "estimated_amount": 5649, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 24234, "standard_charge_percentage": 80.0000, "estimated_amount": 24234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 24234, "standard_charge_percentage": 80.0000, "estimated_amount": 24234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 9087.75, "standard_charge_percentage": 30.0000, "estimated_amount": 9087, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5931.27, "standard_charge_percentage": 19.5800, "estimated_amount": 5931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" }]}]} , { "description": "Repair/graft radius or ulna", "code_information": [ { "code": "25405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38947.5, "discounted_cash": 10936,"minimum": 1715,"maximum": 31158,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 7263.71, "standard_charge_percentage": 18.6500, "estimated_amount": 7263, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 7408.98, "standard_charge_percentage": 19.0200, "estimated_amount": 7408, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 31158, "standard_charge_percentage": 80.0000, "estimated_amount": 31158, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 11684.3, "standard_charge_percentage": 30.0000, "estimated_amount": 11684, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 31158, "standard_charge_percentage": 80.0000, "estimated_amount": 31158, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 7625.92, "standard_charge_percentage": 19.5800, "estimated_amount": 7625, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" }]}]} , { "description": "Arthrp Ntrcrp/Crp/Mtcr Ntrps", "code_information": [ { "code": "25447", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25965, "discounted_cash": 4967,"minimum": 1715,"maximum": 20772,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5667, "estimated_amount": 5667, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7789.5, "standard_charge_percentage": 30.0000, "estimated_amount": 7789, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4842.47, "standard_charge_percentage": 18.6500, "estimated_amount": 4842, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 20772, "standard_charge_percentage": 80.0000, "estimated_amount": 20772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4939.32, "standard_charge_percentage": 19.0200, "estimated_amount": 4939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5083.95, "standard_charge_percentage": 19.5800, "estimated_amount": 5083, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 20772, "standard_charge_percentage": 80.0000, "estimated_amount": 20772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Radial Shaft Fx Wo Amnip", "code_information": [ { "code": "25500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Radial Shaft Fx W Manip", "code_information": [ { "code": "25505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4895.38, "discounted_cash": 2450,"minimum": 912.99,"maximum": 4161.07,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 912.99, "standard_charge_percentage": 18.6500, "estimated_amount": 912, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 4161.07, "standard_charge_percentage": 85.0000, "estimated_amount": 4161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 4161.07, "standard_charge_percentage": 85.0000, "estimated_amount": 4161, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 931.25, "standard_charge_percentage": 19.0200, "estimated_amount": 931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2447.69, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2447, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1468.61, "standard_charge_percentage": 30.0000, "estimated_amount": 1468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 958.52, "standard_charge_percentage": 19.5800, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" }]}]} , { "description": "Optx Radial Shaft Fracture", "code_information": [ { "code": "25515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34620, "discounted_cash": 10936,"minimum": 1715,"maximum": 27696,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 27696, "standard_charge_percentage": 80.0000, "estimated_amount": 27696, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 6585.76, "standard_charge_percentage": 19.0200, "estimated_amount": 6585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 6778.6, "standard_charge_percentage": 19.5800, "estimated_amount": 6778, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 27696, "standard_charge_percentage": 80.0000, "estimated_amount": 27696, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 6456.63, "standard_charge_percentage": 18.6500, "estimated_amount": 6456, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 10386, "standard_charge_percentage": 30.0000, "estimated_amount": 10386, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Ulna Shaft Fx Wo Amnip", "code_information": [ { "code": "25530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Rad/Ulna Shaft Fx W Manip", "code_information": [ { "code": "25565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6598.03, "discounted_cash": 2450,"minimum": 1230.53,"maximum": 5608.33,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1230.53, "standard_charge_percentage": 18.6500, "estimated_amount": 1230, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 5608.33, "standard_charge_percentage": 85.0000, "estimated_amount": 5608, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5278.42, "standard_charge_percentage": 80.0000, "estimated_amount": 5278, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5172.86, "standard_charge_percentage": 78.4000, "estimated_amount": 5172, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1255.14, "standard_charge_percentage": 19.0200, "estimated_amount": 1255, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5172.86, "standard_charge_percentage": 78.4000, "estimated_amount": 5172, "methodology": "percent of total billed charges" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1979.41, "standard_charge_percentage": 30.0000, "estimated_amount": 1979, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1291.89, "standard_charge_percentage": 19.5800, "estimated_amount": 1291, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3299.01, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 5608.33, "standard_charge_percentage": 85.0000, "estimated_amount": 5608, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5278.42, "standard_charge_percentage": 80.0000, "estimated_amount": 5278, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Distl Rad/Ulna Fx Wo Manip", "code_information": [ { "code": "25600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Distl Rad/Ulna Fx W Manip", "code_information": [ { "code": "25605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6598.03, "discounted_cash": 2450,"minimum": 1230.53,"maximum": 14016.4,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 5608.33, "standard_charge_percentage": 85.0000, "estimated_amount": 5608, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1255.14, "standard_charge_percentage": 19.0200, "estimated_amount": 1255, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5172.86, "standard_charge_percentage": 78.4000, "estimated_amount": 5172, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5172.86, "standard_charge_percentage": 78.4000, "estimated_amount": 5172, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5278.42, "standard_charge_percentage": 80.0000, "estimated_amount": 5278, "methodology": "percent of total billed charges" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3267.57, "standard_charge_percentage": 18.6500, "estimated_amount": 3267, "methodology": "percent of total billed charges" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1230.53, "standard_charge_percentage": 18.6500, "estimated_amount": 1230, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3299.01, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 5608.33, "standard_charge_percentage": 85.0000, "estimated_amount": 5608, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1979.41, "standard_charge_percentage": 30.0000, "estimated_amount": 1979, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5278.42, "standard_charge_percentage": 80.0000, "estimated_amount": 5278, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1291.89, "standard_charge_percentage": 19.5800, "estimated_amount": 1291, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3332.92, "standard_charge_percentage": 19.0200, "estimated_amount": 3332, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14016.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14016, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5256.15, "standard_charge_percentage": 30.0000, "estimated_amount": 5256, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3430.51, "standard_charge_percentage": 19.5800, "estimated_amount": 3430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8760.25, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8760, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14016.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14016, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" }]}]} , { "description": "Optx Dst Rd Xartc Fx/Epi Sep", "code_information": [ { "code": "25607", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30292.5, "discounted_cash": 10936,"minimum": 1715,"maximum": 24234,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5762.54, "standard_charge_percentage": 19.0200, "estimated_amount": 5762, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 24234, "standard_charge_percentage": 80.0000, "estimated_amount": 24234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5649.55, "standard_charge_percentage": 18.6500, "estimated_amount": 5649, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 24234, "standard_charge_percentage": 80.0000, "estimated_amount": 24234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 9087.75, "standard_charge_percentage": 30.0000, "estimated_amount": 9087, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5931.27, "standard_charge_percentage": 19.5800, "estimated_amount": 5931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" }]}]} , { "description": "Optx dst rd xart fx/epi sep2", "code_information": [ { "code": "25608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39671.3, "discounted_cash": 10936,"minimum": 1715,"maximum": 31737,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 31737, "standard_charge_percentage": 80.0000, "estimated_amount": 31737, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 7398.7, "standard_charge_percentage": 18.6500, "estimated_amount": 7398, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 7546.67, "standard_charge_percentage": 19.0200, "estimated_amount": 7546, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 7767.64, "standard_charge_percentage": 19.5800, "estimated_amount": 7767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 11901.4, "standard_charge_percentage": 30.0000, "estimated_amount": 11901, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 31737, "standard_charge_percentage": 80.0000, "estimated_amount": 31737, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" }]}]} , { "description": "Optx dst rd xart fx/ep sep3+", "code_information": [ { "code": "25609", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34620, "discounted_cash": 10936,"minimum": 1715,"maximum": 27696,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 6585.76, "standard_charge_percentage": 19.0200, "estimated_amount": 6585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 10386, "standard_charge_percentage": 30.0000, "estimated_amount": 10386, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 6778.6, "standard_charge_percentage": 19.5800, "estimated_amount": 6778, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 6456.63, "standard_charge_percentage": 18.6500, "estimated_amount": 6456, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 27696, "standard_charge_percentage": 80.0000, "estimated_amount": 27696, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 27696, "standard_charge_percentage": 80.0000, "estimated_amount": 27696, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Navicular Fx Wo Manip", "code_information": [ { "code": "25622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Navicular Fx W Manip", "code_information": [ { "code": "25624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4895.38, "discounted_cash": 2450,"minimum": 912.99,"maximum": 4161.07,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 4161.07, "standard_charge_percentage": 85.0000, "estimated_amount": 4161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 4161.07, "standard_charge_percentage": 85.0000, "estimated_amount": 4161, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 931.25, "standard_charge_percentage": 19.0200, "estimated_amount": 931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 912.99, "standard_charge_percentage": 18.6500, "estimated_amount": 912, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2447.69, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2447, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1468.61, "standard_charge_percentage": 30.0000, "estimated_amount": 1468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 958.52, "standard_charge_percentage": 19.5800, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Carpal Fx Ea Bone Wo Manip", "code_information": [ { "code": "25630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" }]}]} , { "description": "Treat fracture ulnar styloid", "code_information": [ { "code": "25652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21519.8, "discounted_cash": 10936,"minimum": 1715,"maximum": 17835.3,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4013.43, "standard_charge_percentage": 18.6500, "estimated_amount": 4013, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4093.7, "standard_charge_percentage": 19.0200, "estimated_amount": 4093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 17215.8, "standard_charge_percentage": 80.0000, "estimated_amount": 17215, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4213.57, "standard_charge_percentage": 19.5800, "estimated_amount": 4213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 17215.8, "standard_charge_percentage": 80.0000, "estimated_amount": 17215, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6455.93, "standard_charge_percentage": 30.0000, "estimated_amount": 6455, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Radioulna Disloc W Manip", "code_information": [ { "code": "25675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Lunate Disloc W Manip", "code_information": [ { "code": "25690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4895.38, "discounted_cash": 2450,"minimum": 912.99,"maximum": 4161.07,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1468.61, "standard_charge_percentage": 30.0000, "estimated_amount": 1468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2447.69, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2447, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 958.52, "standard_charge_percentage": 19.5800, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 4161.07, "standard_charge_percentage": 85.0000, "estimated_amount": 4161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 4161.07, "standard_charge_percentage": 85.0000, "estimated_amount": 4161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 912.99, "standard_charge_percentage": 18.6500, "estimated_amount": 912, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 931.25, "standard_charge_percentage": 19.0200, "estimated_amount": 931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" }]}]} , { "description": "Hc Drain Finger Abscess Simple", "code_information": [ { "code": "26010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 657.7, "discounted_cash": 304,"minimum": 122.66,"maximum": 657.7,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 328.85, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 328, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 657.7, "estimated_amount": 657, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 197.31, "standard_charge_percentage": 30.0000, "estimated_amount": 197, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 526.16, "standard_charge_percentage": 80.0000, "estimated_amount": 526, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 315.9, "estimated_amount": 315, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 245.7, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 515.64, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 122.66, "standard_charge_percentage": 18.6500, "estimated_amount": 122, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 468, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 657.7, "estimated_amount": 657, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 657.7, "estimated_amount": 657, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 657.7, "estimated_amount": 657, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 515.64, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 526.16, "standard_charge_percentage": 80.0000, "estimated_amount": 526, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 128.78, "standard_charge_percentage": 19.5800, "estimated_amount": 128, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 187.2, "estimated_amount": 187, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 343.86, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 496.08, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 125.11, "standard_charge_percentage": 19.0200, "estimated_amount": 125, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 234, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 402.71, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 374.4, "estimated_amount": 374, "methodology": "fee schedule" }]}]} , { "description": "Hc Drain Finger Abscess,Complicated", "code_information": [ { "code": "26011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5127.07, "discounted_cash": 2480,"minimum": 956.2,"maximum": 4101.66,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1538.12, "standard_charge_percentage": 30.0000, "estimated_amount": 1538, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 956.2, "standard_charge_percentage": 18.6500, "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4019.62, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4019, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4101.66, "standard_charge_percentage": 80.0000, "estimated_amount": 4101, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1003.88, "standard_charge_percentage": 19.5800, "estimated_amount": 1003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2563.53, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2563, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4019.62, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4019, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 975.32, "standard_charge_percentage": 19.0200, "estimated_amount": 975, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4101.66, "standard_charge_percentage": 80.0000, "estimated_amount": 4101, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "26045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25243.8, "discounted_cash": 4967,"minimum": 1715,"maximum": 20195,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4942.73, "standard_charge_percentage": 19.5800, "estimated_amount": 4942, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 20195, "standard_charge_percentage": 80.0000, "estimated_amount": 20195, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4707.96, "standard_charge_percentage": 18.6500, "estimated_amount": 4707, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7573.13, "standard_charge_percentage": 30.0000, "estimated_amount": 7573, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4802.12, "standard_charge_percentage": 19.0200, "estimated_amount": 4802, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 20195, "standard_charge_percentage": 80.0000, "estimated_amount": 20195, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Incise finger tendon sheath", "code_information": [ { "code": "26055", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17310, "discounted_cash": 2450,"minimum": 1507.78,"maximum": 13848,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3389.3, "standard_charge_percentage": 19.5800, "estimated_amount": 3389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8655, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3228.32, "standard_charge_percentage": 18.6500, "estimated_amount": 3228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3292.88, "standard_charge_percentage": 19.0200, "estimated_amount": 3292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5193, "standard_charge_percentage": 30.0000, "estimated_amount": 5193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "26080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8655, "discounted_cash": 2450,"minimum": 1507.78,"maximum": 6924,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1646.44, "standard_charge_percentage": 19.0200, "estimated_amount": 1646, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4327.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4327, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1694.65, "standard_charge_percentage": 19.5800, "estimated_amount": 1694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6924, "standard_charge_percentage": 80.0000, "estimated_amount": 6924, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1614.16, "standard_charge_percentage": 18.6500, "estimated_amount": 1614, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6924, "standard_charge_percentage": 80.0000, "estimated_amount": 6924, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2596.5, "standard_charge_percentage": 30.0000, "estimated_amount": 2596, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" }]}]} , { "description": "Exc Hand Les Sc 1.5 Cm/>", "code_information": [ { "code": "26111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 2480,"minimum": 1526.47,"maximum": 12312,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "Exc hand tum deep 1.5 cm/>", "code_information": [ { "code": "26113", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 2480,"minimum": 1526.47,"maximum": 12312,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "Exc Hand Les Sc < 1.5 Cm", "code_information": [ { "code": "26115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17955, "discounted_cash": 2480,"minimum": 1526.47,"maximum": 14364,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3415.58, "standard_charge_percentage": 19.0200, "estimated_amount": 3415, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3515.59, "standard_charge_percentage": 19.5800, "estimated_amount": 3515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5386.5, "standard_charge_percentage": 30.0000, "estimated_amount": 5386, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14364, "standard_charge_percentage": 80.0000, "estimated_amount": 14364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8977.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8977, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3348.61, "standard_charge_percentage": 18.6500, "estimated_amount": 3348, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14364, "standard_charge_percentage": 80.0000, "estimated_amount": 14364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "Exc hand tum deep < 1.5 cm", "code_information": [ { "code": "26116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 2480,"minimum": 1526.47,"maximum": 12312,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "26123", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19233.3, "discounted_cash": 4967,"minimum": 1715,"maximum": 15386.7,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3765.89, "standard_charge_percentage": 19.5800, "estimated_amount": 3765, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3658.76, "standard_charge_percentage": 19.0200, "estimated_amount": 3658, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 15386.7, "standard_charge_percentage": 80.0000, "estimated_amount": 15386, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3587.02, "standard_charge_percentage": 18.6500, "estimated_amount": 3587, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 15386.7, "standard_charge_percentage": 80.0000, "estimated_amount": 15386, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5770, "standard_charge_percentage": 30.0000, "estimated_amount": 5770, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "26160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9234, "discounted_cash": 2450,"minimum": 1507.78,"maximum": 7387.2,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4617, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1808.02, "standard_charge_percentage": 19.5800, "estimated_amount": 1808, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1722.14, "standard_charge_percentage": 18.6500, "estimated_amount": 1722, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1756.58, "standard_charge_percentage": 19.0200, "estimated_amount": 1756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7387.2, "standard_charge_percentage": 80.0000, "estimated_amount": 7387, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2770.2, "standard_charge_percentage": 30.0000, "estimated_amount": 2770, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7387.2, "standard_charge_percentage": 80.0000, "estimated_amount": 7387, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "26210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4488.75, "discounted_cash": 2450,"minimum": 837.15,"maximum": 3995.63,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2244.38, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2244, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 878.9, "standard_charge_percentage": 19.5800, "estimated_amount": 878, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3519.18, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3519, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 853.89, "standard_charge_percentage": 19.0200, "estimated_amount": 853, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3591, "standard_charge_percentage": 80.0000, "estimated_amount": 3591, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1346.63, "standard_charge_percentage": 30.0000, "estimated_amount": 1346, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3519.18, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3519, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 837.15, "standard_charge_percentage": 18.6500, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3591, "standard_charge_percentage": 80.0000, "estimated_amount": 3591, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" }]}]} , { "description": "Hc Part Remv Bone, Distal Phalanx", "code_information": [ { "code": "26236", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4895.38, "discounted_cash": 2450,"minimum": 337,"maximum": 12312,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2447.69, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2447, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 931.25, "standard_charge_percentage": 19.0200, "estimated_amount": 931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1468.61, "standard_charge_percentage": 30.0000, "estimated_amount": 1468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 369, "estimated_amount": 369, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 742, "estimated_amount": 742, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 742, "estimated_amount": 742, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 958.52, "standard_charge_percentage": 19.5800, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 337, "estimated_amount": 337, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 912.99, "standard_charge_percentage": 18.6500, "estimated_amount": 912, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "26340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3449.57, "discounted_cash": 2450,"minimum": 643.34,"maximum": 3449.57,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 2704.46, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2704, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2759.66, "standard_charge_percentage": 80.0000, "estimated_amount": 2759, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 675.43, "standard_charge_percentage": 19.5800, "estimated_amount": 675, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 643.34, "standard_charge_percentage": 18.6500, "estimated_amount": 643, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 656.21, "standard_charge_percentage": 19.0200, "estimated_amount": 656, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1034.87, "standard_charge_percentage": 30.0000, "estimated_amount": 1034, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1724.79, "standard_charge_percentage": 50.0000, "estimated_amount": 1724, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3449.57, "estimated_amount": 3449, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 2704.46, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2704, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2759.66, "standard_charge_percentage": 80.0000, "estimated_amount": 2759, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3449.57, "estimated_amount": 3449, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3449.57, "estimated_amount": 3449, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3449.57, "estimated_amount": 3449, "methodology": "fee schedule" }]}]} , { "description": "Repair Finger/Hand Tendon", "code_information": [ { "code": "26350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23085, "discounted_cash": 4967,"minimum": 1715,"maximum": 18468,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4391.46, "standard_charge_percentage": 19.0200, "estimated_amount": 4391, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 18468, "standard_charge_percentage": 80.0000, "estimated_amount": 18468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4520.04, "standard_charge_percentage": 19.5800, "estimated_amount": 4520, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 18468, "standard_charge_percentage": 80.0000, "estimated_amount": 18468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4305.35, "standard_charge_percentage": 18.6500, "estimated_amount": 4305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6925.5, "standard_charge_percentage": 30.0000, "estimated_amount": 6925, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "26352", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17313.8, "discounted_cash": 10936,"minimum": 1715,"maximum": 17313.8,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17313.8, "estimated_amount": 17313, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17313.8, "estimated_amount": 17313, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5194.13, "standard_charge_percentage": 30.0000, "estimated_amount": 5194, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8656.88, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8656, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3229.02, "standard_charge_percentage": 18.6500, "estimated_amount": 3229, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3293.6, "standard_charge_percentage": 19.0200, "estimated_amount": 3293, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13851, "standard_charge_percentage": 80.0000, "estimated_amount": 13851, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3390.03, "standard_charge_percentage": 19.5800, "estimated_amount": 3390, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13851, "standard_charge_percentage": 80.0000, "estimated_amount": 13851, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "26356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12550.2, "discounted_cash": 4967,"minimum": 1715,"maximum": 10040.2,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2340.61, "standard_charge_percentage": 18.6500, "estimated_amount": 2340, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2387.42, "standard_charge_percentage": 19.0200, "estimated_amount": 2387, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2457.33, "standard_charge_percentage": 19.5800, "estimated_amount": 2457, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10040.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10040, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 6275.1, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 6275, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3765.06, "standard_charge_percentage": 30.0000, "estimated_amount": 3765, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10040.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10040, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "26370", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1646.88, "discounted_cash": 4967,"minimum": 307.14,"maximum": 1646.88,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1646.88, "estimated_amount": 1646, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1646.88, "estimated_amount": 1646, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1646.88, "estimated_amount": 1646, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1646.88, "estimated_amount": 1646, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1646.88, "estimated_amount": 1646, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1646.88, "estimated_amount": 1646, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1646.88, "estimated_amount": 1646, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1646.88, "estimated_amount": 1646, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1291.15, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1291, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 494.06, "standard_charge_percentage": 30.0000, "estimated_amount": 494, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 322.46, "standard_charge_percentage": 19.5800, "estimated_amount": 322, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1646.88, "estimated_amount": 1646, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1646.88, "estimated_amount": 1646, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1646.88, "estimated_amount": 1646, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1646.88, "estimated_amount": 1646, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1646.88, "estimated_amount": 1646, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1646.88, "estimated_amount": 1646, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1646.88, "estimated_amount": 1646, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1646.88, "estimated_amount": 1646, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1646.88, "estimated_amount": 1646, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 307.14, "standard_charge_percentage": 18.6500, "estimated_amount": 307, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1317.5, "standard_charge_percentage": 80.0000, "estimated_amount": 1317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1646.88, "estimated_amount": 1646, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1646.88, "estimated_amount": 1646, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1646.88, "estimated_amount": 1646, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1646.88, "estimated_amount": 1646, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1646.88, "estimated_amount": 1646, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1646.88, "estimated_amount": 1646, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1646.88, "estimated_amount": 1646, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1646.88, "estimated_amount": 1646, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 823.44, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 823, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1291.15, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1291, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 313.29, "standard_charge_percentage": 19.0200, "estimated_amount": 313, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1317.5, "standard_charge_percentage": 80.0000, "estimated_amount": 1317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1646.88, "estimated_amount": 1646, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1646.88, "estimated_amount": 1646, "methodology": "fee schedule" }]}]} , { "description": "Hc Repair Exten Tendon,Dorsum Hand,Ea", "code_information": [ { "code": "26410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4895.38, "discounted_cash": 2450,"minimum": 912.99,"maximum": 3995.63,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1468.61, "standard_charge_percentage": 30.0000, "estimated_amount": 1468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2447.69, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2447, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 912.99, "standard_charge_percentage": 18.6500, "estimated_amount": 912, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 931.25, "standard_charge_percentage": 19.0200, "estimated_amount": 931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 958.52, "standard_charge_percentage": 19.5800, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" }]}]} , { "description": "Hc Repair Exten Tendon Finger Ea", "code_information": [ { "code": "26418", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4895.38, "discounted_cash": 2450,"minimum": 912.99,"maximum": 18308.8,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 912.99, "standard_charge_percentage": 18.6500, "estimated_amount": 912, "methodology": "percent of total billed charges" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4481.08, "standard_charge_percentage": 19.5800, "estimated_amount": 4481, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1468.61, "standard_charge_percentage": 30.0000, "estimated_amount": 1468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 958.52, "standard_charge_percentage": 19.5800, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 18308.8, "standard_charge_percentage": 80.0000, "estimated_amount": 18308, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6865.8, "standard_charge_percentage": 30.0000, "estimated_amount": 6865, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 18308.8, "standard_charge_percentage": 80.0000, "estimated_amount": 18308, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2447.69, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2447, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 931.25, "standard_charge_percentage": 19.0200, "estimated_amount": 931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4268.24, "standard_charge_percentage": 18.6500, "estimated_amount": 4268, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4353.6, "standard_charge_percentage": 19.0200, "estimated_amount": 4353, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" }]}]} , { "description": "Repair Finger Tendon", "code_information": [ { "code": "26433", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50017.5, "discounted_cash": 4967,"minimum": 1715,"maximum": 40014,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 9328.26, "standard_charge_percentage": 18.6500, "estimated_amount": 9328, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 9514.83, "standard_charge_percentage": 19.0200, "estimated_amount": 9514, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 40014, "standard_charge_percentage": 80.0000, "estimated_amount": 40014, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 40014, "standard_charge_percentage": 80.0000, "estimated_amount": 40014, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 9793.43, "standard_charge_percentage": 19.5800, "estimated_amount": 9793, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 15005.3, "standard_charge_percentage": 30.0000, "estimated_amount": 15005, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "26440", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8656.87, "discounted_cash": 2450,"minimum": 1507.78,"maximum": 6925.5,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1614.51, "standard_charge_percentage": 18.6500, "estimated_amount": 1614, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6925.5, "standard_charge_percentage": 80.0000, "estimated_amount": 6925, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4328.44, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4328, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1695.02, "standard_charge_percentage": 19.5800, "estimated_amount": 1695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1646.8, "standard_charge_percentage": 19.0200, "estimated_amount": 1646, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6925.5, "standard_charge_percentage": 80.0000, "estimated_amount": 6925, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2597.06, "standard_charge_percentage": 30.0000, "estimated_amount": 2597, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "26520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 4967,"minimum": 1715,"maximum": 12312,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "26525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4949.06, "discounted_cash": 2450,"minimum": 923,"maximum": 3995.63,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1484.72, "standard_charge_percentage": 30.0000, "estimated_amount": 1484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 923, "standard_charge_percentage": 18.6500, "estimated_amount": 923, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3959.25, "standard_charge_percentage": 80.0000, "estimated_amount": 3959, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3880.06, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3880, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 941.46, "standard_charge_percentage": 19.0200, "estimated_amount": 941, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3959.25, "standard_charge_percentage": 80.0000, "estimated_amount": 3959, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 969.03, "standard_charge_percentage": 19.5800, "estimated_amount": 969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2474.53, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2474, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3880.06, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "26593", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9376.25, "discounted_cash": 4967,"minimum": 1715,"maximum": 8100.6,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4688.13, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4688, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7501, "standard_charge_percentage": 80.0000, "estimated_amount": 7501, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1748.67, "standard_charge_percentage": 18.6500, "estimated_amount": 1748, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2812.88, "standard_charge_percentage": 30.0000, "estimated_amount": 2812, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1783.64, "standard_charge_percentage": 19.0200, "estimated_amount": 1783, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1835.87, "standard_charge_percentage": 19.5800, "estimated_amount": 1835, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7501, "standard_charge_percentage": 80.0000, "estimated_amount": 7501, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Metacarpal Fx Wo Manip Ea", "code_information": [ { "code": "26600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Metacarpal Fx W Manip Ea", "code_information": [ { "code": "26605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 13848,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3228.32, "standard_charge_percentage": 18.6500, "estimated_amount": 3228, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3292.88, "standard_charge_percentage": 19.0200, "estimated_amount": 3292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5193, "standard_charge_percentage": 30.0000, "estimated_amount": 5193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3389.3, "standard_charge_percentage": 19.5800, "estimated_amount": 3389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8655, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" }]}]} , { "description": "Treat Metacarpal Fracture", "code_information": [ { "code": "26608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25965, "discounted_cash": 4967,"minimum": 1715,"maximum": 20772,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5083.95, "standard_charge_percentage": 19.5800, "estimated_amount": 5083, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4939.32, "standard_charge_percentage": 19.0200, "estimated_amount": 4939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 20772, "standard_charge_percentage": 80.0000, "estimated_amount": 20772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4842.47, "standard_charge_percentage": 18.6500, "estimated_amount": 4842, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7789.5, "standard_charge_percentage": 30.0000, "estimated_amount": 7789, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 20772, "standard_charge_percentage": 80.0000, "estimated_amount": 20772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Treat metacarpal fracture", "code_information": [ { "code": "26615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20805.8, "discounted_cash": 4967,"minimum": 1715,"maximum": 16644.6,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6241.74, "standard_charge_percentage": 30.0000, "estimated_amount": 6241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 16644.6, "standard_charge_percentage": 80.0000, "estimated_amount": 16644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3957.89, "standard_charge_percentage": 19.0200, "estimated_amount": 3957, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 16644.6, "standard_charge_percentage": 80.0000, "estimated_amount": 16644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3880.28, "standard_charge_percentage": 18.6500, "estimated_amount": 3880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4073.78, "standard_charge_percentage": 19.5800, "estimated_amount": 4073, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat C-Mc Disloc W Manip W Anes Ea", "code_information": [ { "code": "26675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4895.38, "discounted_cash": 2450,"minimum": 912.99,"maximum": 4161.07,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 4161.07, "standard_charge_percentage": 85.0000, "estimated_amount": 4161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1468.61, "standard_charge_percentage": 30.0000, "estimated_amount": 1468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2447.69, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2447, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 912.99, "standard_charge_percentage": 18.6500, "estimated_amount": 912, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 4161.07, "standard_charge_percentage": 85.0000, "estimated_amount": 4161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 958.52, "standard_charge_percentage": 19.5800, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 931.25, "standard_charge_percentage": 19.0200, "estimated_amount": 931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" }]}]} , { "description": "Pin Hand Dislocation", "code_information": [ { "code": "26676", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13867.5, "discounted_cash": 4967,"minimum": 1715,"maximum": 11094,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2638.01, "standard_charge_percentage": 19.0200, "estimated_amount": 2638, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 11094, "standard_charge_percentage": 80.0000, "estimated_amount": 11094, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 6933.75, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 6933, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 11094, "standard_charge_percentage": 80.0000, "estimated_amount": 11094, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4160.25, "standard_charge_percentage": 30.0000, "estimated_amount": 4160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2586.29, "standard_charge_percentage": 18.6500, "estimated_amount": 2586, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2715.26, "standard_charge_percentage": 19.5800, "estimated_amount": 2715, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Mc-P Disloc W Manip Wo Anes", "code_information": [ { "code": "26700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 968.12, "discounted_cash": 367,"minimum": 180.55,"maximum": 968.12,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 968.12, "estimated_amount": 968, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 484.06, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 822.9, "standard_charge_percentage": 85.0000, "estimated_amount": 822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 822.9, "standard_charge_percentage": 85.0000, "estimated_amount": 822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 759.01, "standard_charge_percentage": 78.4000, "estimated_amount": 759, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 759.01, "standard_charge_percentage": 78.4000, "estimated_amount": 759, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 774.5, "standard_charge_percentage": 80.0000, "estimated_amount": 774, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 184.17, "standard_charge_percentage": 19.0200, "estimated_amount": 184, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 774.5, "standard_charge_percentage": 80.0000, "estimated_amount": 774, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 290.44, "standard_charge_percentage": 30.0000, "estimated_amount": 290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 968.12, "estimated_amount": 968, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 180.55, "standard_charge_percentage": 18.6500, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 189.56, "standard_charge_percentage": 19.5800, "estimated_amount": 189, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Prox/Mid Fing Shft Fx Wo Manip Ea", "code_information": [ { "code": "26720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Prox/Mid Fing Shft Fx W Manip Ea", "code_information": [ { "code": "26725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Treat Finger Fracture Each", "code_information": [ { "code": "26727", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18393, "discounted_cash": 4967,"minimum": 1715,"maximum": 14714.4,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3498.9, "standard_charge_percentage": 19.0200, "estimated_amount": 3498, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3430.29, "standard_charge_percentage": 18.6500, "estimated_amount": 3430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14714.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3601.35, "standard_charge_percentage": 19.5800, "estimated_amount": 3601, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5517.9, "standard_charge_percentage": 30.0000, "estimated_amount": 5517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14714.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Treat Finger Fracture Each", "code_information": [ { "code": "26735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29361.4, "discounted_cash": 4967,"minimum": 1715,"maximum": 23489.1,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5475.9, "standard_charge_percentage": 18.6500, "estimated_amount": 5475, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5585.42, "standard_charge_percentage": 19.0200, "estimated_amount": 5585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 23489.1, "standard_charge_percentage": 80.0000, "estimated_amount": 23489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8808.42, "standard_charge_percentage": 30.0000, "estimated_amount": 8808, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 23489.1, "standard_charge_percentage": 80.0000, "estimated_amount": 23489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5748.96, "standard_charge_percentage": 19.5800, "estimated_amount": 5748, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Fingr Articular Fx W Manip Ea", "code_information": [ { "code": "26742", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6598.03, "discounted_cash": 2450,"minimum": 1230.53,"maximum": 5608.33,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 5608.33, "standard_charge_percentage": 85.0000, "estimated_amount": 5608, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1255.14, "standard_charge_percentage": 19.0200, "estimated_amount": 1255, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5172.86, "standard_charge_percentage": 78.4000, "estimated_amount": 5172, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5278.42, "standard_charge_percentage": 80.0000, "estimated_amount": 5278, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1230.53, "standard_charge_percentage": 18.6500, "estimated_amount": 1230, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 5608.33, "standard_charge_percentage": 85.0000, "estimated_amount": 5608, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5278.42, "standard_charge_percentage": 80.0000, "estimated_amount": 5278, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1979.41, "standard_charge_percentage": 30.0000, "estimated_amount": 1979, "methodology": "percent of total billed charges" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3299.01, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5172.86, "standard_charge_percentage": 78.4000, "estimated_amount": 5172, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1291.89, "standard_charge_percentage": 19.5800, "estimated_amount": 1291, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" }]}]} , { "description": "TREAT FINGER FRACTURE EACH", "code_information": [ { "code": "26746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34620, "discounted_cash": 4967,"minimum": 1715,"maximum": 27696,"payers_information":[{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 27696, "standard_charge_percentage": 80.0000, "estimated_amount": 27696, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 6585.76, "standard_charge_percentage": 19.0200, "estimated_amount": 6585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 27696, "standard_charge_percentage": 80.0000, "estimated_amount": 27696, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 6778.6, "standard_charge_percentage": 19.5800, "estimated_amount": 6778, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 6456.63, "standard_charge_percentage": 18.6500, "estimated_amount": 6456, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 10386, "standard_charge_percentage": 30.0000, "estimated_amount": 10386, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" }]}]} , { "description": "TREAT FINGER FRACTURE EACH", "code_information": [ { "code": "26750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Dist Fingr Fx W Manip Ea", "code_information": [ { "code": "26755", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Pin Finger Fracture Each", "code_information": [ { "code": "26756", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25965, "discounted_cash": 4967,"minimum": 1715,"maximum": 20772,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4939.32, "standard_charge_percentage": 19.0200, "estimated_amount": 4939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4842.47, "standard_charge_percentage": 18.6500, "estimated_amount": 4842, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5083.95, "standard_charge_percentage": 19.5800, "estimated_amount": 5083, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 20772, "standard_charge_percentage": 80.0000, "estimated_amount": 20772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 20772, "standard_charge_percentage": 80.0000, "estimated_amount": 20772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7789.5, "standard_charge_percentage": 30.0000, "estimated_amount": 7789, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Hc Open Treat Dist Phalangeal Fx Ea", "code_information": [ { "code": "26765", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13288.2, "discounted_cash": 4967,"minimum": 2478.25,"maximum": 11295,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10630.6, "standard_charge_percentage": 80.0000, "estimated_amount": 10630, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2478.25, "standard_charge_percentage": 18.6500, "estimated_amount": 2478, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 11295, "standard_charge_percentage": 85.0000, "estimated_amount": 11294, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2527.81, "standard_charge_percentage": 19.0200, "estimated_amount": 2527, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3986.46, "standard_charge_percentage": 30.0000, "estimated_amount": 3986, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2601.83, "standard_charge_percentage": 19.5800, "estimated_amount": 2601, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 10418, "standard_charge_percentage": 78.4000, "estimated_amount": 10417, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 6644.1, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 6644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10630.6, "standard_charge_percentage": 80.0000, "estimated_amount": 10630, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 11295, "standard_charge_percentage": 85.0000, "estimated_amount": 11294, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 10418, "standard_charge_percentage": 78.4000, "estimated_amount": 10417, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Ip Jnt Disloc W Manip Wo Anes", "code_information": [ { "code": "26770", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 968.12, "discounted_cash": 367,"minimum": 180.55,"maximum": 968.12,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 968.12, "estimated_amount": 968, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 759.01, "standard_charge_percentage": 78.4000, "estimated_amount": 759, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 774.5, "standard_charge_percentage": 80.0000, "estimated_amount": 774, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 822.9, "standard_charge_percentage": 85.0000, "estimated_amount": 822, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 184.17, "standard_charge_percentage": 19.0200, "estimated_amount": 184, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 774.5, "standard_charge_percentage": 80.0000, "estimated_amount": 774, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 822.9, "standard_charge_percentage": 85.0000, "estimated_amount": 822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 290.44, "standard_charge_percentage": 30.0000, "estimated_amount": 290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 968.12, "estimated_amount": 968, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 484.06, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 180.55, "standard_charge_percentage": 18.6500, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 189.56, "standard_charge_percentage": 19.5800, "estimated_amount": 189, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 759.01, "standard_charge_percentage": 78.4000, "estimated_amount": 759, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Ip Jnt Disloc W Manip W Anes", "code_information": [ { "code": "26775", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 878.11, "discounted_cash": 406,"minimum": 163.77,"maximum": 878.11,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 878.11, "estimated_amount": 878, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 163.77, "standard_charge_percentage": 18.6500, "estimated_amount": 163, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 167.04, "standard_charge_percentage": 19.0200, "estimated_amount": 167, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 702.49, "standard_charge_percentage": 80.0000, "estimated_amount": 702, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 625.52, "estimated_amount": 625, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 663.05, "estimated_amount": 663, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 439.06, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 171.93, "standard_charge_percentage": 19.5800, "estimated_amount": 171, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 422.23, "estimated_amount": 422, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 538.26, "estimated_amount": 538, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 500.42, "estimated_amount": 500, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 459.6, "estimated_amount": 459, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 878.11, "estimated_amount": 878, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 263.43, "standard_charge_percentage": 30.0000, "estimated_amount": 263, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 688.44, "standard_charge_percentage": 78.4000, "estimated_amount": 688, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 250.21, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 437.86, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 328.4, "estimated_amount": 328, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 746.39, "standard_charge_percentage": 85.0000, "estimated_amount": 746, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 746.39, "standard_charge_percentage": 85.0000, "estimated_amount": 746, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 688.44, "standard_charge_percentage": 78.4000, "estimated_amount": 688, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 702.49, "standard_charge_percentage": 80.0000, "estimated_amount": 702, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 538.26, "estimated_amount": 538, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 538.26, "estimated_amount": 538, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 625.52, "estimated_amount": 625, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 663.05, "estimated_amount": 663, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "26785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3659.79, "discounted_cash": 4967,"minimum": 682.55,"maximum": 3659.79,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 2869.28, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 682.55, "standard_charge_percentage": 18.6500, "estimated_amount": 682, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1097.94, "standard_charge_percentage": 30.0000, "estimated_amount": 1097, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2927.83, "standard_charge_percentage": 80.0000, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 3659.79, "estimated_amount": 3659, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3659.79, "estimated_amount": 3659, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3659.79, "estimated_amount": 3659, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3659.79, "estimated_amount": 3659, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3659.79, "estimated_amount": 3659, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3659.79, "estimated_amount": 3659, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3659.79, "estimated_amount": 3659, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3659.79, "estimated_amount": 3659, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3659.79, "estimated_amount": 3659, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3659.79, "estimated_amount": 3659, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3659.79, "estimated_amount": 3659, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3659.79, "estimated_amount": 3659, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3659.79, "estimated_amount": 3659, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3659.79, "estimated_amount": 3659, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3659.79, "estimated_amount": 3659, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1829.89, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1829, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 716.59, "standard_charge_percentage": 19.5800, "estimated_amount": 716, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3659.79, "estimated_amount": 3659, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3659.79, "estimated_amount": 3659, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3659.79, "estimated_amount": 3659, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3659.79, "estimated_amount": 3659, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3659.79, "estimated_amount": 3659, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3659.79, "estimated_amount": 3659, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3659.79, "estimated_amount": 3659, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 2869.28, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2869, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 696.2, "standard_charge_percentage": 19.0200, "estimated_amount": 696, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2927.83, "standard_charge_percentage": 80.0000, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3659.79, "estimated_amount": 3659, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3659.79, "estimated_amount": 3659, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "26850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17955, "discounted_cash": 10936,"minimum": 1715,"maximum": 17835.3,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8977.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8977, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3415.58, "standard_charge_percentage": 19.0200, "estimated_amount": 3415, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14364, "standard_charge_percentage": 80.0000, "estimated_amount": 14364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14364, "standard_charge_percentage": 80.0000, "estimated_amount": 14364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3348.61, "standard_charge_percentage": 18.6500, "estimated_amount": 3348, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3515.59, "standard_charge_percentage": 19.5800, "estimated_amount": 3515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5386.5, "standard_charge_percentage": 30.0000, "estimated_amount": 5386, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "26860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10900, "discounted_cash": 4967,"minimum": 1715,"maximum": 8720,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8720, "standard_charge_percentage": 80.0000, "estimated_amount": 8720, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5450, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5450, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2032.85, "standard_charge_percentage": 18.6500, "estimated_amount": 2032, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3270, "standard_charge_percentage": 30.0000, "estimated_amount": 3270, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2134.22, "standard_charge_percentage": 19.5800, "estimated_amount": 2134, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2073.51, "standard_charge_percentage": 19.0200, "estimated_amount": 2073, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8720, "standard_charge_percentage": 80.0000, "estimated_amount": 8720, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Hc Amputation Of Finger/Thumb", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9778.3, "discounted_cash": 4967,"minimum": 1715,"maximum": 13848,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1823.65, "standard_charge_percentage": 18.6500, "estimated_amount": 1823, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7822.64, "standard_charge_percentage": 80.0000, "estimated_amount": 7822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2933.49, "standard_charge_percentage": 30.0000, "estimated_amount": 2933, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1914.59, "standard_charge_percentage": 19.5800, "estimated_amount": 1914, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1860.13, "standard_charge_percentage": 19.0200, "estimated_amount": 1860, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7822.64, "standard_charge_percentage": 80.0000, "estimated_amount": 7822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3292.88, "standard_charge_percentage": 19.0200, "estimated_amount": 3292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4889.15, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3228.32, "standard_charge_percentage": 18.6500, "estimated_amount": 3228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5193, "standard_charge_percentage": 30.0000, "estimated_amount": 5193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3389.3, "standard_charge_percentage": 19.5800, "estimated_amount": 3389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8655, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Hc Amp F/Th 1/2 Jt/Phalanx W/Neurect Local Flap", "code_information": [ { "code": "26952", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9778.3, "discounted_cash": 4967,"minimum": 1715,"maximum": 17310,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1914.59, "standard_charge_percentage": 19.5800, "estimated_amount": 1914, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1823.65, "standard_charge_percentage": 18.6500, "estimated_amount": 1823, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7822.64, "standard_charge_percentage": 80.0000, "estimated_amount": 7822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2933.49, "standard_charge_percentage": 30.0000, "estimated_amount": 2933, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1860.13, "standard_charge_percentage": 19.0200, "estimated_amount": 1860, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7822.64, "standard_charge_percentage": 80.0000, "estimated_amount": 7822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 17310, "standard_charge_percentage": 80.0000, "estimated_amount": 17310, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 17310, "standard_charge_percentage": 80.0000, "estimated_amount": 17310, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4889.15, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4035.39, "standard_charge_percentage": 18.6500, "estimated_amount": 4035, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6491.25, "standard_charge_percentage": 30.0000, "estimated_amount": 6491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4116.1, "standard_charge_percentage": 19.0200, "estimated_amount": 4116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4236.62, "standard_charge_percentage": 19.5800, "estimated_amount": 4236, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "26990", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17310, "discounted_cash": 4967,"minimum": 1715,"maximum": 13848,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8655, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5193, "standard_charge_percentage": 30.0000, "estimated_amount": 5193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3389.3, "standard_charge_percentage": 19.5800, "estimated_amount": 3389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3228.32, "standard_charge_percentage": 18.6500, "estimated_amount": 3228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3292.88, "standard_charge_percentage": 19.0200, "estimated_amount": 3292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" }]}]} , { "description": "Hc Biopsy Of Soft Tissues", "code_information": [ { "code": "27040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6863, "discounted_cash": 2480,"minimum": 1279.95,"maximum": 5490.4,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3431.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3431, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5490.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2058.9, "standard_charge_percentage": 30.0000, "estimated_amount": 2058, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1279.95, "standard_charge_percentage": 18.6500, "estimated_amount": 1279, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1305.55, "standard_charge_percentage": 19.0200, "estimated_amount": 1305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1343.78, "standard_charge_percentage": 19.5800, "estimated_amount": 1343, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5490.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "Exc hip pelvis les sc 3 cm/>", "code_information": [ { "code": "27043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16672.5, "discounted_cash": 4381,"minimum": 1715,"maximum": 13338,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13338, "standard_charge_percentage": 80.0000, "estimated_amount": 13338, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5001.75, "standard_charge_percentage": 30.0000, "estimated_amount": 5001, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13338, "standard_charge_percentage": 80.0000, "estimated_amount": 13338, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8336.25, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8336, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3171.61, "standard_charge_percentage": 19.0200, "estimated_amount": 3171, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3109.42, "standard_charge_percentage": 18.6500, "estimated_amount": 3109, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3264.48, "standard_charge_percentage": 19.5800, "estimated_amount": 3264, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" }]}]} , { "description": "Exc Hip/Pelv Tum Deep 5 Cm/>", "code_information": [ { "code": "27045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23085, "discounted_cash": 4381,"minimum": 1715,"maximum": 18468,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4305.35, "standard_charge_percentage": 18.6500, "estimated_amount": 4305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 18468, "standard_charge_percentage": 80.0000, "estimated_amount": 18468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6925.5, "standard_charge_percentage": 30.0000, "estimated_amount": 6925, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4391.46, "standard_charge_percentage": 19.0200, "estimated_amount": 4391, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4520.04, "standard_charge_percentage": 19.5800, "estimated_amount": 4520, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 18468, "standard_charge_percentage": 80.0000, "estimated_amount": 18468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" }]}]} , { "description": "Exc Hip/Pelvis Les Sc < 3 Cm", "code_information": [ { "code": "27047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21802.5, "discounted_cash": 4381,"minimum": 1715,"maximum": 17442,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4147.49, "standard_charge_percentage": 19.0200, "estimated_amount": 4147, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4066.17, "standard_charge_percentage": 18.6500, "estimated_amount": 4066, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 17442, "standard_charge_percentage": 80.0000, "estimated_amount": 17442, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6540.75, "standard_charge_percentage": 30.0000, "estimated_amount": 6540, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4268.93, "standard_charge_percentage": 19.5800, "estimated_amount": 4268, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 17442, "standard_charge_percentage": 80.0000, "estimated_amount": 17442, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" }]}]} , { "description": "Exc Hip/Pelv Tum Deep < 5 Cm", "code_information": [ { "code": "27048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17310, "discounted_cash": 4381,"minimum": 1715,"maximum": 13848,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3389.3, "standard_charge_percentage": 19.5800, "estimated_amount": 3389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8655, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5193, "standard_charge_percentage": 30.0000, "estimated_amount": 5193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3228.32, "standard_charge_percentage": 18.6500, "estimated_amount": 3228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3292.88, "standard_charge_percentage": 19.0200, "estimated_amount": 3292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" }]}]} , { "description": "Inject Sacroiliac Joint", "code_information": [ { "code": "27096", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13986,"minimum": 1715,"maximum": 11188.8,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 6993, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 6993, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2608.39, "standard_charge_percentage": 18.6500, "estimated_amount": 2608, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4195.8, "standard_charge_percentage": 30.0000, "estimated_amount": 4195, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2738.46, "standard_charge_percentage": 19.5800, "estimated_amount": 2738, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 11188.8, "standard_charge_percentage": 80.0000, "estimated_amount": 11188, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 11188.8, "standard_charge_percentage": 80.0000, "estimated_amount": 11188, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2660.56, "standard_charge_percentage": 19.0200, "estimated_amount": 2660, "methodology": "percent of total billed charges" }]}]} , { "description": "Total hip arthroplasty", "code_information": [ { "code": "27130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 63739.5, "discounted_cash": 19698,"minimum": 1715,"maximum": 50991.6,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 26077.8, "estimated_amount": 26077, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 21213.8, "estimated_amount": 21213, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 22266.9, "estimated_amount": 22266, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 11887.4, "standard_charge_percentage": 18.6500, "estimated_amount": 11887, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 12125.2, "standard_charge_percentage": 19.0200, "estimated_amount": 12125, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 19121.8, "standard_charge_percentage": 30.0000, "estimated_amount": 19121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 50991.6, "standard_charge_percentage": 80.0000, "estimated_amount": 50991, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 24244.4, "estimated_amount": 24244, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 12480.2, "standard_charge_percentage": 19.5800, "estimated_amount": 12480, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 12122.2, "estimated_amount": 12122, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 15910.4, "estimated_amount": 15910, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 32123.8, "estimated_amount": 32123, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 32123.8, "estimated_amount": 32123, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 7566, "estimated_amount": 7566, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 50991.6, "standard_charge_percentage": 80.0000, "estimated_amount": 50991, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 20456.2, "estimated_amount": 20456, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 26077.8, "estimated_amount": 26077, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 26077.8, "estimated_amount": 26077, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 30305.5, "estimated_amount": 30305, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 30305.5, "estimated_amount": 30305, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Traumatic Hip Disloc Wo Anes", "code_information": [ { "code": "27250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" }]}]} , { "description": "Hc Closed Rx Spont Hip Disloc,Anesth", "code_information": [ { "code": "27257", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4895.38, "discounted_cash": 2450,"minimum": 912.99,"maximum": 4161.07,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 4161.07, "standard_charge_percentage": 85.0000, "estimated_amount": 4161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 4161.07, "standard_charge_percentage": 85.0000, "estimated_amount": 4161, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 931.25, "standard_charge_percentage": 19.0200, "estimated_amount": 931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2447.69, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2447, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 912.99, "standard_charge_percentage": 18.6500, "estimated_amount": 912, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 958.52, "standard_charge_percentage": 19.5800, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1468.61, "standard_charge_percentage": 30.0000, "estimated_amount": 1468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Post Hip Arthrplas Disloc W Anes", "code_information": [ { "code": "27265", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" }]}]} , { "description": "Hc I&D Thigh/Knee Abscess,Deep", "code_information": [ { "code": "27301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8864.9, "discounted_cash": 4381,"minimum": 1653.3,"maximum": 13848,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2659.47, "standard_charge_percentage": 30.0000, "estimated_amount": 2659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3389.3, "standard_charge_percentage": 19.5800, "estimated_amount": 3389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4432.45, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4432, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1653.3, "standard_charge_percentage": 18.6500, "estimated_amount": 1653, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7091.92, "standard_charge_percentage": 80.0000, "estimated_amount": 7091, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1735.75, "standard_charge_percentage": 19.5800, "estimated_amount": 1735, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1686.37, "standard_charge_percentage": 19.0200, "estimated_amount": 1686, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7091.92, "standard_charge_percentage": 80.0000, "estimated_amount": 7091, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3292.88, "standard_charge_percentage": 19.0200, "estimated_amount": 3292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5193, "standard_charge_percentage": 30.0000, "estimated_amount": 5193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8655, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3228.32, "standard_charge_percentage": 18.6500, "estimated_amount": 3228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27327", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15268.1, "discounted_cash": 2480,"minimum": 1526.47,"maximum": 12214.5,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2847.51, "standard_charge_percentage": 18.6500, "estimated_amount": 2847, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2904.46, "standard_charge_percentage": 19.0200, "estimated_amount": 2904, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4580.44, "standard_charge_percentage": 30.0000, "estimated_amount": 4580, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12214.5, "standard_charge_percentage": 80.0000, "estimated_amount": 12214, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7634.06, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7634, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12214.5, "standard_charge_percentage": 80.0000, "estimated_amount": 12214, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2989.5, "standard_charge_percentage": 19.5800, "estimated_amount": 2989, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "Exc thigh/knee les sc 3 cm/>", "code_information": [ { "code": "27337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 4381,"minimum": 1715,"maximum": 12312,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" }]}]} , { "description": "Exc thigh/knee tum dep 5cm/>", "code_information": [ { "code": "27339", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30780, "discounted_cash": 4381,"minimum": 1715,"maximum": 24624,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5855.28, "standard_charge_percentage": 19.0200, "estimated_amount": 5855, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 24624, "standard_charge_percentage": 80.0000, "estimated_amount": 24624, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 24624, "standard_charge_percentage": 80.0000, "estimated_amount": 24624, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5740.47, "standard_charge_percentage": 18.6500, "estimated_amount": 5740, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 9234, "standard_charge_percentage": 30.0000, "estimated_amount": 9234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 6026.72, "standard_charge_percentage": 19.5800, "estimated_amount": 6026, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" }]}]} , { "description": "Repair Of Kneecap Tendon", "code_information": [ { "code": "27380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39851.5, "discounted_cash": 10936,"minimum": 1715,"maximum": 31881.2,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 31881.2, "standard_charge_percentage": 80.0000, "estimated_amount": 31881, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 11955.5, "standard_charge_percentage": 30.0000, "estimated_amount": 11955, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 7802.92, "standard_charge_percentage": 19.5800, "estimated_amount": 7802, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 31881.2, "standard_charge_percentage": 80.0000, "estimated_amount": 31881, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 7432.3, "standard_charge_percentage": 18.6500, "estimated_amount": 7432, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 7580.95, "standard_charge_percentage": 19.0200, "estimated_amount": 7580, "methodology": "percent of total billed charges" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" }]}]} , { "description": "Repair of thigh muscle", "code_information": [ { "code": "27385", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 63297, "discounted_cash": 10936,"minimum": 1715,"maximum": 50637.6,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 12041, "standard_charge_percentage": 19.0200, "estimated_amount": 12040, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 12393.5, "standard_charge_percentage": 19.5800, "estimated_amount": 12393, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 18989.1, "standard_charge_percentage": 30.0000, "estimated_amount": 18989, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 11804.9, "standard_charge_percentage": 18.6500, "estimated_amount": 11804, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 50637.6, "standard_charge_percentage": 80.0000, "estimated_amount": 50637, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 50637.6, "standard_charge_percentage": 80.0000, "estimated_amount": 50637, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27412", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27996.8, "discounted_cash": 10936,"minimum": 1715,"maximum": 22397.4,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 22397.4, "standard_charge_percentage": 80.0000, "estimated_amount": 22397, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5221.39, "standard_charge_percentage": 18.6500, "estimated_amount": 5221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 22397.4, "standard_charge_percentage": 80.0000, "estimated_amount": 22397, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8399.02, "standard_charge_percentage": 30.0000, "estimated_amount": 8399, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5325.82, "standard_charge_percentage": 19.0200, "estimated_amount": 5325, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5481.76, "standard_charge_percentage": 19.5800, "estimated_amount": 5481, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27418", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7212.5, "discounted_cash": 10936,"minimum": 1345.13,"maximum": 7212.5,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5770, "standard_charge_percentage": 80.0000, "estimated_amount": 5770, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5770, "standard_charge_percentage": 80.0000, "estimated_amount": 5770, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2163.75, "standard_charge_percentage": 30.0000, "estimated_amount": 2163, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1412.21, "standard_charge_percentage": 19.5800, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5667, "estimated_amount": 5667, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3606.25, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3606, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1345.13, "standard_charge_percentage": 18.6500, "estimated_amount": 1345, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1372.03, "standard_charge_percentage": 19.0200, "estimated_amount": 1372, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27422", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9738, "discounted_cash": 10936,"minimum": 1715,"maximum": 9738,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1852.46, "standard_charge_percentage": 19.0200, "estimated_amount": 1852, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 9738, "estimated_amount": 9738, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 9738, "estimated_amount": 9738, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 9738, "estimated_amount": 9738, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 9738, "estimated_amount": 9738, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4869, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1816.14, "standard_charge_percentage": 18.6500, "estimated_amount": 1816, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7790.4, "standard_charge_percentage": 80.0000, "estimated_amount": 7790, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7790.4, "standard_charge_percentage": 80.0000, "estimated_amount": 7790, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 9738, "estimated_amount": 9738, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 9738, "estimated_amount": 9738, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5667, "estimated_amount": 5667, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 9738, "estimated_amount": 9738, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 9738, "estimated_amount": 9738, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9738, "estimated_amount": 9738, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 9738, "estimated_amount": 9738, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 9738, "estimated_amount": 9738, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2921.4, "standard_charge_percentage": 30.0000, "estimated_amount": 2921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1906.7, "standard_charge_percentage": 19.5800, "estimated_amount": 1906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27427", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29446.5, "discounted_cash": 10936,"minimum": 1715,"maximum": 23557.2,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5601.61, "standard_charge_percentage": 19.0200, "estimated_amount": 5601, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5491.77, "standard_charge_percentage": 18.6500, "estimated_amount": 5491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 23557.2, "standard_charge_percentage": 80.0000, "estimated_amount": 23557, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 23557.2, "standard_charge_percentage": 80.0000, "estimated_amount": 23557, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8833.95, "standard_charge_percentage": 30.0000, "estimated_amount": 8833, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5765.62, "standard_charge_percentage": 19.5800, "estimated_amount": 5765, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" }]}]} , { "description": "Revision Of Knee Joint", "code_information": [ { "code": "27446", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43821, "discounted_cash": 19698,"minimum": 1715,"maximum": 35056.8,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 13146.3, "standard_charge_percentage": 30.0000, "estimated_amount": 13146, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 8580.15, "standard_charge_percentage": 19.5800, "estimated_amount": 8580, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 12122.2, "estimated_amount": 12122, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 21213.8, "estimated_amount": 21213, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 15910.4, "estimated_amount": 15910, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 7566, "estimated_amount": 7566, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 8172.62, "standard_charge_percentage": 18.6500, "estimated_amount": 8172, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 35056.8, "standard_charge_percentage": 80.0000, "estimated_amount": 35056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 26077.8, "estimated_amount": 26077, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 26077.8, "estimated_amount": 26077, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 22266.9, "estimated_amount": 22266, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 20456.2, "estimated_amount": 20456, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 30305.5, "estimated_amount": 30305, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 30305.5, "estimated_amount": 30305, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 8336.07, "standard_charge_percentage": 19.0200, "estimated_amount": 8336, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 35056.8, "standard_charge_percentage": 80.0000, "estimated_amount": 35056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 26077.8, "estimated_amount": 26077, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 24244.4, "estimated_amount": 24244, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 32123.8, "estimated_amount": 32123, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 32123.8, "estimated_amount": 32123, "methodology": "fee schedule" }]}]} , { "description": "Total knee arthroplasty", "code_information": [ { "code": "27447", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 63297, "discounted_cash": 19698,"minimum": 1715,"maximum": 50637.6,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 7566, "estimated_amount": 7566, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 50637.6, "standard_charge_percentage": 80.0000, "estimated_amount": 50637, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 18989.1, "standard_charge_percentage": 30.0000, "estimated_amount": 18989, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 50637.6, "standard_charge_percentage": 80.0000, "estimated_amount": 50637, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 26077.8, "estimated_amount": 26077, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 26077.8, "estimated_amount": 26077, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 12041, "standard_charge_percentage": 19.0200, "estimated_amount": 12040, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 12393.5, "standard_charge_percentage": 19.5800, "estimated_amount": 12393, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 12122.2, "estimated_amount": 12122, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 26077.8, "estimated_amount": 26077, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 24244.4, "estimated_amount": 24244, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 21213.8, "estimated_amount": 21213, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 22266.9, "estimated_amount": 22266, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 15910.4, "estimated_amount": 15910, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 32123.8, "estimated_amount": 32123, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 32123.8, "estimated_amount": 32123, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 11804.9, "standard_charge_percentage": 18.6500, "estimated_amount": 11804, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 20456.2, "estimated_amount": 20456, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 30305.5, "estimated_amount": 30305, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 30305.5, "estimated_amount": 30305, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Femur Shaft Fx W Manip", "code_information": [ { "code": "27502", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4895.38, "discounted_cash": 2450,"minimum": 912.99,"maximum": 4161.07,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2447.69, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2447, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1468.61, "standard_charge_percentage": 30.0000, "estimated_amount": 1468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 912.99, "standard_charge_percentage": 18.6500, "estimated_amount": 912, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 931.25, "standard_charge_percentage": 19.0200, "estimated_amount": 931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 4161.07, "standard_charge_percentage": 85.0000, "estimated_amount": 4161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 4161.07, "standard_charge_percentage": 85.0000, "estimated_amount": 4161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 958.52, "standard_charge_percentage": 19.5800, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27524", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46253.3, "discounted_cash": 10936,"minimum": 1715,"maximum": 37002.6,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 8626.23, "standard_charge_percentage": 18.6500, "estimated_amount": 8626, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 37002.6, "standard_charge_percentage": 80.0000, "estimated_amount": 37002, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 9056.39, "standard_charge_percentage": 19.5800, "estimated_amount": 9056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 8798.76, "standard_charge_percentage": 19.0200, "estimated_amount": 8798, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 37002.6, "standard_charge_percentage": 80.0000, "estimated_amount": 37002, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 13876, "standard_charge_percentage": 30.0000, "estimated_amount": 13875, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Tibial Plateau Fx Wo Manip", "code_information": [ { "code": "27530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Patellr Disloc Wo Anes", "code_information": [ { "code": "27560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 968.12, "discounted_cash": 367,"minimum": 180.55,"maximum": 968.12,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 180.55, "standard_charge_percentage": 18.6500, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 822.9, "standard_charge_percentage": 85.0000, "estimated_amount": 822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 968.12, "estimated_amount": 968, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 290.44, "standard_charge_percentage": 30.0000, "estimated_amount": 290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 189.56, "standard_charge_percentage": 19.5800, "estimated_amount": 189, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 484.06, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 759.01, "standard_charge_percentage": 78.4000, "estimated_amount": 759, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 968.12, "estimated_amount": 968, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 822.9, "standard_charge_percentage": 85.0000, "estimated_amount": 822, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 184.17, "standard_charge_percentage": 19.0200, "estimated_amount": 184, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 774.5, "standard_charge_percentage": 80.0000, "estimated_amount": 774, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 759.01, "standard_charge_percentage": 78.4000, "estimated_amount": 759, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 774.5, "standard_charge_percentage": 80.0000, "estimated_amount": 774, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" }]}]} , { "description": "Treat Kneecap Dislocation", "code_information": [ { "code": "27562", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34627.5, "discounted_cash": 367,"minimum": 225.99,"maximum": 27702,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 6587.19, "standard_charge_percentage": 19.0200, "estimated_amount": 6587, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 6458.03, "standard_charge_percentage": 18.6500, "estimated_amount": 6458, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 27702, "standard_charge_percentage": 80.0000, "estimated_amount": 27702, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 10388.3, "standard_charge_percentage": 30.0000, "estimated_amount": 10388, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 6780.06, "standard_charge_percentage": 19.5800, "estimated_amount": 6780, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 27702, "standard_charge_percentage": 80.0000, "estimated_amount": 27702, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27594", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17310, "discounted_cash": 4967,"minimum": 1715,"maximum": 13848,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3389.3, "standard_charge_percentage": 19.5800, "estimated_amount": 3389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8655, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8655, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3292.88, "standard_charge_percentage": 19.0200, "estimated_amount": 3292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5193, "standard_charge_percentage": 30.0000, "estimated_amount": 5193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3228.32, "standard_charge_percentage": 18.6500, "estimated_amount": 3228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27599", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 42166.2, "discounted_cash": 367,"minimum": 225.99,"maximum": 33732.9,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 7863.99, "standard_charge_percentage": 18.6500, "estimated_amount": 7863, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 8256.14, "standard_charge_percentage": 19.5800, "estimated_amount": 8256, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 8021.27, "standard_charge_percentage": 19.0200, "estimated_amount": 8021, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 33732.9, "standard_charge_percentage": 80.0000, "estimated_amount": 33732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12649.9, "standard_charge_percentage": 30.0000, "estimated_amount": 12649, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 33732.9, "standard_charge_percentage": 80.0000, "estimated_amount": 33732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17310, "discounted_cash": 4381,"minimum": 1715,"maximum": 13848,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3228.32, "standard_charge_percentage": 18.6500, "estimated_amount": 3228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3292.88, "standard_charge_percentage": 19.0200, "estimated_amount": 3292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5193, "standard_charge_percentage": 30.0000, "estimated_amount": 5193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3389.3, "standard_charge_percentage": 19.5800, "estimated_amount": 3389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8655, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17751.5, "discounted_cash": 4967,"minimum": 1715,"maximum": 14201.2,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8875.76, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8875, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3376.87, "standard_charge_percentage": 19.0200, "estimated_amount": 3376, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14201.2, "standard_charge_percentage": 80.0000, "estimated_amount": 14201, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14201.2, "standard_charge_percentage": 80.0000, "estimated_amount": 14201, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5325.46, "standard_charge_percentage": 30.0000, "estimated_amount": 5325, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3310.66, "standard_charge_percentage": 18.6500, "estimated_amount": 3310, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3475.75, "standard_charge_percentage": 19.5800, "estimated_amount": 3475, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6491.25, "discounted_cash": 4967,"minimum": 1210.62,"maximum": 6491.25,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5089.14, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5089, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1234.83, "standard_charge_percentage": 19.0200, "estimated_amount": 1234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5193, "standard_charge_percentage": 80.0000, "estimated_amount": 5193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1947.38, "standard_charge_percentage": 30.0000, "estimated_amount": 1947, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5193, "standard_charge_percentage": 80.0000, "estimated_amount": 5193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6491.25, "estimated_amount": 6491, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 6491.25, "estimated_amount": 6491, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3245.63, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3245, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1270.99, "standard_charge_percentage": 19.5800, "estimated_amount": 1270, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6491.25, "estimated_amount": 6491, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6491.25, "estimated_amount": 6491, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 6491.25, "estimated_amount": 6491, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5089.14, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5089, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6491.25, "estimated_amount": 6491, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1210.62, "standard_charge_percentage": 18.6500, "estimated_amount": 1210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6491.25, "estimated_amount": 6491, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12473.5, "discounted_cash": 4967,"minimum": 1715,"maximum": 9978.78,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 6236.73, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 6236, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2326.3, "standard_charge_percentage": 18.6500, "estimated_amount": 2326, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2442.31, "standard_charge_percentage": 19.5800, "estimated_amount": 2442, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9978.78, "standard_charge_percentage": 80.0000, "estimated_amount": 9978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2372.83, "standard_charge_percentage": 19.0200, "estimated_amount": 2372, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9978.78, "standard_charge_percentage": 80.0000, "estimated_amount": 9978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3742.04, "standard_charge_percentage": 30.0000, "estimated_amount": 3742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Exc leg/ankle tum < 3 cm", "code_information": [ { "code": "27618", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19237.5, "discounted_cash": 2480,"minimum": 1526.47,"maximum": 15390,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3587.79, "standard_charge_percentage": 18.6500, "estimated_amount": 3587, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 15390, "standard_charge_percentage": 80.0000, "estimated_amount": 15390, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3766.7, "standard_charge_percentage": 19.5800, "estimated_amount": 3766, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 15390, "standard_charge_percentage": 80.0000, "estimated_amount": 15390, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3659.55, "standard_charge_percentage": 19.0200, "estimated_amount": 3659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5771.25, "standard_charge_percentage": 30.0000, "estimated_amount": 5771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" }]}]} , { "description": "Exc Leg/Ankle Tum Deep <5 Cm", "code_information": [ { "code": "27619", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 4381,"minimum": 1715,"maximum": 12312,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15296.6, "discounted_cash": 4967,"minimum": 1715,"maximum": 12237.3,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4588.99, "standard_charge_percentage": 30.0000, "estimated_amount": 4588, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12237.3, "standard_charge_percentage": 80.0000, "estimated_amount": 12237, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7648.31, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7648, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2852.82, "standard_charge_percentage": 18.6500, "estimated_amount": 2852, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2909.88, "standard_charge_percentage": 19.0200, "estimated_amount": 2909, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12237.3, "standard_charge_percentage": 80.0000, "estimated_amount": 12237, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2995.08, "standard_charge_percentage": 19.5800, "estimated_amount": 2995, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Exc legankle les sc 3 cm>", "code_information": [ { "code": "27632", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19473.8, "discounted_cash": 4381,"minimum": 1715,"maximum": 15579,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3704.49, "standard_charge_percentage": 19.0200, "estimated_amount": 3704, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 15579, "standard_charge_percentage": 80.0000, "estimated_amount": 15579, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3812.96, "standard_charge_percentage": 19.5800, "estimated_amount": 3812, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3631.85, "standard_charge_percentage": 18.6500, "estimated_amount": 3631, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5842.13, "standard_charge_percentage": 30.0000, "estimated_amount": 5842, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 15579, "standard_charge_percentage": 80.0000, "estimated_amount": 15579, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20241, "discounted_cash": 4967,"minimum": 1715,"maximum": 16192.8,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3774.95, "standard_charge_percentage": 18.6500, "estimated_amount": 3774, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 16192.8, "standard_charge_percentage": 80.0000, "estimated_amount": 16192, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6072.3, "standard_charge_percentage": 30.0000, "estimated_amount": 6072, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3850.45, "standard_charge_percentage": 19.0200, "estimated_amount": 3850, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3963.19, "standard_charge_percentage": 19.5800, "estimated_amount": 3963, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 16192.8, "standard_charge_percentage": 80.0000, "estimated_amount": 16192, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21971.6, "discounted_cash": 4967,"minimum": 1715,"maximum": 17577.3,"payers_information":[{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 17577.3, "standard_charge_percentage": 80.0000, "estimated_amount": 17577, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4097.71, "standard_charge_percentage": 18.6500, "estimated_amount": 4097, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4302.05, "standard_charge_percentage": 19.5800, "estimated_amount": 4302, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4179.66, "standard_charge_percentage": 19.0200, "estimated_amount": 4179, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6591.49, "standard_charge_percentage": 30.0000, "estimated_amount": 6591, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 17577.3, "standard_charge_percentage": 80.0000, "estimated_amount": 17577, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27641", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15812, "discounted_cash": 4967,"minimum": 1715,"maximum": 12649.6,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3007.91, "standard_charge_percentage": 19.0200, "estimated_amount": 3007, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4743.59, "standard_charge_percentage": 30.0000, "estimated_amount": 4743, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3095.98, "standard_charge_percentage": 19.5800, "estimated_amount": 3095, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2948.93, "standard_charge_percentage": 18.6500, "estimated_amount": 2948, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12649.6, "standard_charge_percentage": 80.0000, "estimated_amount": 12649, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7905.98, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7905, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12649.6, "standard_charge_percentage": 80.0000, "estimated_amount": 12649, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Hc Inj For Ankle X-Ray", "code_information": [ { "code": "27648", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 878.6,"minimum": 163.86,"maximum": 878.6,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 878.6, "estimated_amount": 878, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 746.81, "standard_charge_percentage": 85.0000, "estimated_amount": 746, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 167.14, "standard_charge_percentage": 19.0200, "estimated_amount": 167, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 702.88, "standard_charge_percentage": 80.0000, "estimated_amount": 702, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 263.58, "standard_charge_percentage": 30.0000, "estimated_amount": 263, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 172.03, "standard_charge_percentage": 19.5800, "estimated_amount": 172, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 163.86, "standard_charge_percentage": 18.6500, "estimated_amount": 163, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 702.88, "standard_charge_percentage": 80.0000, "estimated_amount": 702, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 746.81, "standard_charge_percentage": 85.0000, "estimated_amount": 746, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 688.82, "standard_charge_percentage": 78.4000, "estimated_amount": 688, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 878.6, "estimated_amount": 878, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 439.3, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 688.82, "standard_charge_percentage": 78.4000, "estimated_amount": 688, "methodology": "percent of total billed charges" }]}]} , { "description": "Repair Achilles Tendon", "code_information": [ { "code": "27650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28128.8, "discounted_cash": 10936,"minimum": 1715,"maximum": 22503,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5350.94, "standard_charge_percentage": 19.0200, "estimated_amount": 5350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5507.62, "standard_charge_percentage": 19.5800, "estimated_amount": 5507, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 22503, "standard_charge_percentage": 80.0000, "estimated_amount": 22503, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5667, "estimated_amount": 5667, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8438.64, "standard_charge_percentage": 30.0000, "estimated_amount": 8438, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 22503, "standard_charge_percentage": 80.0000, "estimated_amount": 22503, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5246.02, "standard_charge_percentage": 18.6500, "estimated_amount": 5246, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25965, "discounted_cash": 10936,"minimum": 1715,"maximum": 20772,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5083.95, "standard_charge_percentage": 19.5800, "estimated_amount": 5083, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 20772, "standard_charge_percentage": 80.0000, "estimated_amount": 20772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4939.32, "standard_charge_percentage": 19.0200, "estimated_amount": 4939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 20772, "standard_charge_percentage": 80.0000, "estimated_amount": 20772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7789.5, "standard_charge_percentage": 30.0000, "estimated_amount": 7789, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5667, "estimated_amount": 5667, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4842.47, "standard_charge_percentage": 18.6500, "estimated_amount": 4842, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" }]}]} , { "description": "Repair of achilles tendon", "code_information": [ { "code": "27654", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61560, "discounted_cash": 10936,"minimum": 1715,"maximum": 49248,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 49248, "standard_charge_percentage": 80.0000, "estimated_amount": 49248, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 12053.5, "standard_charge_percentage": 19.5800, "estimated_amount": 12053, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 49248, "standard_charge_percentage": 80.0000, "estimated_amount": 49248, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 11480.9, "standard_charge_percentage": 18.6500, "estimated_amount": 11480, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 11710.6, "standard_charge_percentage": 19.0200, "estimated_amount": 11710, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 18468, "standard_charge_percentage": 30.0000, "estimated_amount": 18468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5667, "estimated_amount": 5667, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" }]}]} , { "description": "Repair of leg tendon each", "code_information": [ { "code": "27658", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23235.4, "discounted_cash": 4967,"minimum": 1715,"maximum": 18588.3,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4420.08, "standard_charge_percentage": 19.0200, "estimated_amount": 4420, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6970.63, "standard_charge_percentage": 30.0000, "estimated_amount": 6970, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4333.41, "standard_charge_percentage": 18.6500, "estimated_amount": 4333, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 18588.3, "standard_charge_percentage": 80.0000, "estimated_amount": 18588, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4549.5, "standard_charge_percentage": 19.5800, "estimated_amount": 4549, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 18588.3, "standard_charge_percentage": 80.0000, "estimated_amount": 18588, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Repair Of Leg Tendon Each", "code_information": [ { "code": "27664", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56257.5, "discounted_cash": 10936,"minimum": 1715,"maximum": 45006,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 16877.3, "standard_charge_percentage": 30.0000, "estimated_amount": 16877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 11015.2, "standard_charge_percentage": 19.5800, "estimated_amount": 11015, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 45006, "standard_charge_percentage": 80.0000, "estimated_amount": 45006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 45006, "standard_charge_percentage": 80.0000, "estimated_amount": 45006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 10492, "standard_charge_percentage": 18.6500, "estimated_amount": 10492, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 10701.9, "standard_charge_percentage": 19.0200, "estimated_amount": 10701, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37492, "discounted_cash": 4967,"minimum": 1715,"maximum": 29993.6,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 7132.1, "standard_charge_percentage": 19.0200, "estimated_amount": 7132, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 11247.6, "standard_charge_percentage": 30.0000, "estimated_amount": 11247, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 7340.93, "standard_charge_percentage": 19.5800, "estimated_amount": 7340, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 6992.26, "standard_charge_percentage": 18.6500, "estimated_amount": 6992, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 29993.6, "standard_charge_percentage": 80.0000, "estimated_amount": 29993, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 29993.6, "standard_charge_percentage": 80.0000, "estimated_amount": 29993, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27676", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18393.2, "discounted_cash": 10936,"minimum": 1715,"maximum": 17835.3,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3498.94, "standard_charge_percentage": 19.0200, "estimated_amount": 3498, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14714.5, "standard_charge_percentage": 80.0000, "estimated_amount": 14714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3430.33, "standard_charge_percentage": 18.6500, "estimated_amount": 3430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14714.5, "standard_charge_percentage": 80.0000, "estimated_amount": 14714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5517.96, "standard_charge_percentage": 30.0000, "estimated_amount": 5517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3601.39, "standard_charge_percentage": 19.5800, "estimated_amount": 3601, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" }]}]} , { "description": "Release Of Lower Leg Tendon", "code_information": [ { "code": "27680", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29766.6, "discounted_cash": 4967,"minimum": 1715,"maximum": 23813.3,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5662.5, "standard_charge_percentage": 19.0200, "estimated_amount": 5662, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 23813.3, "standard_charge_percentage": 80.0000, "estimated_amount": 23813, "methodology": "percent of total billed charges" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5551.47, "standard_charge_percentage": 18.6500, "estimated_amount": 5551, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8929.98, "standard_charge_percentage": 30.0000, "estimated_amount": 8929, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5828.3, "standard_charge_percentage": 19.5800, "estimated_amount": 5828, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 23813.3, "standard_charge_percentage": 80.0000, "estimated_amount": 23813, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27685", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8062.23, "discounted_cash": 4967,"minimum": 1503.61,"maximum": 8062.23,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4031.11, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4031, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8062.23, "estimated_amount": 8062, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1533.68, "standard_charge_percentage": 19.0200, "estimated_amount": 1533, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6449.78, "standard_charge_percentage": 80.0000, "estimated_amount": 6449, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2418.67, "standard_charge_percentage": 30.0000, "estimated_amount": 2418, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6449.78, "standard_charge_percentage": 80.0000, "estimated_amount": 6449, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1503.61, "standard_charge_percentage": 18.6500, "estimated_amount": 1503, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8062.23, "estimated_amount": 8062, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1578.58, "standard_charge_percentage": 19.5800, "estimated_amount": 1578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" }]}]} , { "description": "Revision of calf tendon", "code_information": [ { "code": "27687", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19237.5, "discounted_cash": 4967,"minimum": 1715,"maximum": 15390,"payers_information":[{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3659.55, "standard_charge_percentage": 19.0200, "estimated_amount": 3659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3587.79, "standard_charge_percentage": 18.6500, "estimated_amount": 3587, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5771.25, "standard_charge_percentage": 30.0000, "estimated_amount": 5771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 15390, "standard_charge_percentage": 80.0000, "estimated_amount": 15390, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3766.7, "standard_charge_percentage": 19.5800, "estimated_amount": 3766, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 15390, "standard_charge_percentage": 80.0000, "estimated_amount": 15390, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27691", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20195, "discounted_cash": 10936,"minimum": 1715,"maximum": 17835.3,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3766.37, "standard_charge_percentage": 18.6500, "estimated_amount": 3766, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 16156, "standard_charge_percentage": 80.0000, "estimated_amount": 16156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5667, "estimated_amount": 5667, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3841.69, "standard_charge_percentage": 19.0200, "estimated_amount": 3841, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 16156, "standard_charge_percentage": 80.0000, "estimated_amount": 16156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6058.5, "standard_charge_percentage": 30.0000, "estimated_amount": 6058, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3954.18, "standard_charge_percentage": 19.5800, "estimated_amount": 3954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27695", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21742.4, "discounted_cash": 10936,"minimum": 1715,"maximum": 17835.3,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4257.16, "standard_charge_percentage": 19.5800, "estimated_amount": 4257, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4054.96, "standard_charge_percentage": 18.6500, "estimated_amount": 4054, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4136.06, "standard_charge_percentage": 19.0200, "estimated_amount": 4136, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 17393.9, "standard_charge_percentage": 80.0000, "estimated_amount": 17393, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 17393.9, "standard_charge_percentage": 80.0000, "estimated_amount": 17393, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6522.72, "standard_charge_percentage": 30.0000, "estimated_amount": 6522, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27696", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16228.6, "discounted_cash": 10936,"minimum": 1715,"maximum": 16228.6,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3026.64, "standard_charge_percentage": 18.6500, "estimated_amount": 3026, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12982.9, "standard_charge_percentage": 80.0000, "estimated_amount": 12982, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4868.59, "standard_charge_percentage": 30.0000, "estimated_amount": 4868, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3177.57, "standard_charge_percentage": 19.5800, "estimated_amount": 3177, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 16228.6, "estimated_amount": 16228, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8114.32, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8114, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3087.17, "standard_charge_percentage": 19.0200, "estimated_amount": 3087, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12982.9, "standard_charge_percentage": 80.0000, "estimated_amount": 12982, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16228.6, "estimated_amount": 16228, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16228.6, "estimated_amount": 16228, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 16228.6, "estimated_amount": 16228, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27698", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21201.4, "discounted_cash": 10936,"minimum": 1715,"maximum": 17835.3,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3954.06, "standard_charge_percentage": 18.6500, "estimated_amount": 3954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 16961.1, "standard_charge_percentage": 80.0000, "estimated_amount": 16961, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4033.14, "standard_charge_percentage": 19.0200, "estimated_amount": 4033, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 16961.1, "standard_charge_percentage": 80.0000, "estimated_amount": 16961, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4151.23, "standard_charge_percentage": 19.5800, "estimated_amount": 4151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6360.41, "standard_charge_percentage": 30.0000, "estimated_amount": 6360, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 49776.3, "discounted_cash": 28154,"minimum": 1715,"maximum": 45913.3,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 14932.9, "standard_charge_percentage": 30.0000, "estimated_amount": 14932, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 29237.3, "estimated_amount": 29237, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 17325.8, "estimated_amount": 17325, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 34651.6, "estimated_amount": 34651, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 30320.1, "estimated_amount": 30320, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 43314.4, "estimated_amount": 43314, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 43314.4, "estimated_amount": 43314, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 31825.3, "estimated_amount": 31825, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 9283.27, "standard_charge_percentage": 18.6500, "estimated_amount": 9283, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 9468.94, "standard_charge_percentage": 19.0200, "estimated_amount": 9468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 39821, "standard_charge_percentage": 80.0000, "estimated_amount": 39821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 37272.1, "estimated_amount": 37272, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 22740.1, "estimated_amount": 22740, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 37272.1, "estimated_amount": 37272, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 45913.3, "estimated_amount": 45913, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 39821, "standard_charge_percentage": 80.0000, "estimated_amount": 39821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 9746.19, "standard_charge_percentage": 19.5800, "estimated_amount": 9746, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 37272.1, "estimated_amount": 37272, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 21657.2, "estimated_amount": 21657, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 45913.3, "estimated_amount": 45913, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27704", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26780, "discounted_cash": 4967,"minimum": 1715,"maximum": 21424,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8034, "standard_charge_percentage": 30.0000, "estimated_amount": 8034, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5243.52, "standard_charge_percentage": 19.5800, "estimated_amount": 5243, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 21424, "standard_charge_percentage": 80.0000, "estimated_amount": 21424, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 21424, "standard_charge_percentage": 80.0000, "estimated_amount": 21424, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5094.36, "standard_charge_percentage": 19.0200, "estimated_amount": 5094, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4994.47, "standard_charge_percentage": 18.6500, "estimated_amount": 4994, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Tibia Shaft Fx Wo Manip", "code_information": [ { "code": "27750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Treatment Of Tibia Fracture", "code_information": [ { "code": "27759", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58428, "discounted_cash": 19698,"minimum": 1715,"maximum": 46742.4,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 10896.8, "standard_charge_percentage": 18.6500, "estimated_amount": 10896, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 46742.4, "standard_charge_percentage": 80.0000, "estimated_amount": 46742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 12122.2, "estimated_amount": 12122, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 46742.4, "standard_charge_percentage": 80.0000, "estimated_amount": 46742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 26077.8, "estimated_amount": 26077, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 26077.8, "estimated_amount": 26077, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 26077.8, "estimated_amount": 26077, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 22266.9, "estimated_amount": 22266, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 11114.8, "standard_charge_percentage": 19.0200, "estimated_amount": 11114, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 17528.4, "standard_charge_percentage": 30.0000, "estimated_amount": 17528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 11440.2, "standard_charge_percentage": 19.5800, "estimated_amount": 11440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 24244.4, "estimated_amount": 24244, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 21213.8, "estimated_amount": 21213, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 15910.4, "estimated_amount": 15910, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 32123.8, "estimated_amount": 32123, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 32123.8, "estimated_amount": 32123, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 20456.2, "estimated_amount": 20456, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 30305.5, "estimated_amount": 30305, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 30305.5, "estimated_amount": 30305, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Med Malleolus Fx Wo Manip", "code_information": [ { "code": "27760", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Optx Medial Ankle Fx", "code_information": [ { "code": "27766", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43275, "discounted_cash": 10936,"minimum": 1715,"maximum": 34620,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 8473.24, "standard_charge_percentage": 19.5800, "estimated_amount": 8473, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 8070.79, "standard_charge_percentage": 18.6500, "estimated_amount": 8070, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 8232.2, "standard_charge_percentage": 19.0200, "estimated_amount": 8232, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 34620, "standard_charge_percentage": 80.0000, "estimated_amount": 34620, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12982.5, "standard_charge_percentage": 30.0000, "estimated_amount": 12982, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 34620, "standard_charge_percentage": 80.0000, "estimated_amount": 34620, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Prox/Shaft Fibula Fx Wo Manip", "code_information": [ { "code": "27780", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27784", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11540, "discounted_cash": 10936,"minimum": 1715,"maximum": 11540,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5770, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5770, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9232, "standard_charge_percentage": 80.0000, "estimated_amount": 9232, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 11540, "estimated_amount": 11540, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 11540, "estimated_amount": 11540, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2152.21, "standard_charge_percentage": 18.6500, "estimated_amount": 2152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2259.53, "standard_charge_percentage": 19.5800, "estimated_amount": 2259, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9232, "standard_charge_percentage": 80.0000, "estimated_amount": 9232, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 11540, "estimated_amount": 11540, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 11540, "estimated_amount": 11540, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2195.25, "standard_charge_percentage": 19.0200, "estimated_amount": 2195, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3462, "standard_charge_percentage": 30.0000, "estimated_amount": 3462, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 11540, "estimated_amount": 11540, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 11540, "estimated_amount": 11540, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 11540, "estimated_amount": 11540, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 11540, "estimated_amount": 11540, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11540, "estimated_amount": 11540, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 11540, "estimated_amount": 11540, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Dist Fibula Fx Wo Manip", "code_information": [ { "code": "27786", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Dist Fibula Fx W Manip", "code_information": [ { "code": "27788", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 15580.8,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3704.92, "standard_charge_percentage": 19.0200, "estimated_amount": 3704, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3813.4, "standard_charge_percentage": 19.5800, "estimated_amount": 3813, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 15580.8, "standard_charge_percentage": 80.0000, "estimated_amount": 15580, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3632.27, "standard_charge_percentage": 18.6500, "estimated_amount": 3632, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 15580.8, "standard_charge_percentage": 80.0000, "estimated_amount": 15580, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5842.8, "standard_charge_percentage": 30.0000, "estimated_amount": 5842, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Treatment of ankle fracture", "code_information": [ { "code": "27792", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43171.3, "discounted_cash": 10936,"minimum": 1715,"maximum": 34537,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 34537, "standard_charge_percentage": 80.0000, "estimated_amount": 34537, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 8452.94, "standard_charge_percentage": 19.5800, "estimated_amount": 8452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 8051.45, "standard_charge_percentage": 18.6500, "estimated_amount": 8051, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 34537, "standard_charge_percentage": 80.0000, "estimated_amount": 34537, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12951.4, "standard_charge_percentage": 30.0000, "estimated_amount": 12951, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 8212.48, "standard_charge_percentage": 19.0200, "estimated_amount": 8212, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Bimalleolar Ankle Fx W/O Manip", "code_information": [ { "code": "27808", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Bimalleolar Ankle Fx W Manip", "code_information": [ { "code": "27810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4895.38, "discounted_cash": 2450,"minimum": 912.99,"maximum": 4161.07,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1468.61, "standard_charge_percentage": 30.0000, "estimated_amount": 1468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 958.52, "standard_charge_percentage": 19.5800, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 4161.07, "standard_charge_percentage": 85.0000, "estimated_amount": 4161, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 931.25, "standard_charge_percentage": 19.0200, "estimated_amount": 931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 4161.07, "standard_charge_percentage": 85.0000, "estimated_amount": 4161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2447.69, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2447, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 912.99, "standard_charge_percentage": 18.6500, "estimated_amount": 912, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" }]}]} , { "description": "Treatment of ankle fracture", "code_information": [ { "code": "27814", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57613.5, "discounted_cash": 10936,"minimum": 1715,"maximum": 46090.8,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 10744.9, "standard_charge_percentage": 18.6500, "estimated_amount": 10744, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 11280.7, "standard_charge_percentage": 19.5800, "estimated_amount": 11280, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 10959.8, "standard_charge_percentage": 19.0200, "estimated_amount": 10959, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 46090.8, "standard_charge_percentage": 80.0000, "estimated_amount": 46090, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 17284, "standard_charge_percentage": 30.0000, "estimated_amount": 17284, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 46090.8, "standard_charge_percentage": 80.0000, "estimated_amount": 46090, "methodology": "percent of total billed charges" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Trimalleolar Fx Wo Manip", "code_information": [ { "code": "27816", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Trimalleolar Fx W Manip", "code_information": [ { "code": "27818", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6598.03, "discounted_cash": 2450,"minimum": 1230.53,"maximum": 5608.33,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3299.01, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1230.53, "standard_charge_percentage": 18.6500, "estimated_amount": 1230, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1291.89, "standard_charge_percentage": 19.5800, "estimated_amount": 1291, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1255.14, "standard_charge_percentage": 19.0200, "estimated_amount": 1255, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5172.86, "standard_charge_percentage": 78.4000, "estimated_amount": 5172, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5172.86, "standard_charge_percentage": 78.4000, "estimated_amount": 5172, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 5608.33, "standard_charge_percentage": 85.0000, "estimated_amount": 5608, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5278.42, "standard_charge_percentage": 80.0000, "estimated_amount": 5278, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5278.42, "standard_charge_percentage": 80.0000, "estimated_amount": 5278, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 5608.33, "standard_charge_percentage": 85.0000, "estimated_amount": 5608, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1979.41, "standard_charge_percentage": 30.0000, "estimated_amount": 1979, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" }]}]} , { "description": "Treatment Of Ankle Fracture", "code_information": [ { "code": "27823", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82222.5, "discounted_cash": 10936,"minimum": 1715,"maximum": 65778,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 15334.5, "standard_charge_percentage": 18.6500, "estimated_amount": 15334, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 15641.2, "standard_charge_percentage": 19.0200, "estimated_amount": 15641, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 65778, "standard_charge_percentage": 80.0000, "estimated_amount": 65778, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 24666.8, "standard_charge_percentage": 30.0000, "estimated_amount": 24666, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 65778, "standard_charge_percentage": 80.0000, "estimated_amount": 65778, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 16099.2, "standard_charge_percentage": 19.5800, "estimated_amount": 16099, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Weight Bear Dist Tib W Manip", "code_information": [ { "code": "27825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4895.38, "discounted_cash": 2450,"minimum": 912.99,"maximum": 4161.07,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 4161.07, "standard_charge_percentage": 85.0000, "estimated_amount": 4161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 4161.07, "standard_charge_percentage": 85.0000, "estimated_amount": 4161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 912.99, "standard_charge_percentage": 18.6500, "estimated_amount": 912, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 958.52, "standard_charge_percentage": 19.5800, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2447.69, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2447, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 931.25, "standard_charge_percentage": 19.0200, "estimated_amount": 931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1468.61, "standard_charge_percentage": 30.0000, "estimated_amount": 1468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27827", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64920, "discounted_cash": 19698,"minimum": 1715,"maximum": 51936,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 51936, "standard_charge_percentage": 80.0000, "estimated_amount": 51936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 12711.3, "standard_charge_percentage": 19.5800, "estimated_amount": 12711, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 51936, "standard_charge_percentage": 80.0000, "estimated_amount": 51936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 26077.8, "estimated_amount": 26077, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 26077.8, "estimated_amount": 26077, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 26077.8, "estimated_amount": 26077, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 22266.9, "estimated_amount": 22266, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 32123.8, "estimated_amount": 32123, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 19476, "standard_charge_percentage": 30.0000, "estimated_amount": 19476, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 15910.4, "estimated_amount": 15910, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 32123.8, "estimated_amount": 32123, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 12349.7, "standard_charge_percentage": 19.0200, "estimated_amount": 12349, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 20456.2, "estimated_amount": 20456, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 30305.5, "estimated_amount": 30305, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 30305.5, "estimated_amount": 30305, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 12107.6, "standard_charge_percentage": 18.6500, "estimated_amount": 12107, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 12122.2, "estimated_amount": 12122, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 24244.4, "estimated_amount": 24244, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 21213.8, "estimated_amount": 21213, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27829", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17801.4, "discounted_cash": 10936,"minimum": 1715,"maximum": 17801.4,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14241.2, "standard_charge_percentage": 80.0000, "estimated_amount": 14241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8900.72, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3485.52, "standard_charge_percentage": 19.5800, "estimated_amount": 3485, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17801.4, "estimated_amount": 17801, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5340.43, "standard_charge_percentage": 30.0000, "estimated_amount": 5340, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14241.2, "standard_charge_percentage": 80.0000, "estimated_amount": 14241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3319.97, "standard_charge_percentage": 18.6500, "estimated_amount": 3319, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3386.37, "standard_charge_percentage": 19.0200, "estimated_amount": 3386, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17801.4, "estimated_amount": 17801, "methodology": "fee schedule" }]}]} , { "description": "Treat lower leg dislocation", "code_information": [ { "code": "27830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Ankle Disloc Wo Anes", "code_information": [ { "code": "27840", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Hc Manipulation Ankle Under General Anesthesia", "code_information": [ { "code": "27860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13116.7, "discounted_cash": 4967,"minimum": 1715,"maximum": 10493.4,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 6558.35, "standard_charge_percentage": 50.0000, "estimated_amount": 6558, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2446.26, "standard_charge_percentage": 18.6500, "estimated_amount": 2446, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2495.19, "standard_charge_percentage": 19.0200, "estimated_amount": 2495, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2568.25, "standard_charge_percentage": 19.5800, "estimated_amount": 2568, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10493.4, "standard_charge_percentage": 80.0000, "estimated_amount": 10493, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10493.4, "standard_charge_percentage": 80.0000, "estimated_amount": 10493, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3935.01, "standard_charge_percentage": 30.0000, "estimated_amount": 3935, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16318.3, "discounted_cash": 19698,"minimum": 1715,"maximum": 16318.3,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3043.36, "standard_charge_percentage": 18.6500, "estimated_amount": 3043, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3104.23, "standard_charge_percentage": 19.0200, "estimated_amount": 3104, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 16318.3, "estimated_amount": 16318, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 16318.3, "estimated_amount": 16318, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16318.3, "estimated_amount": 16318, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4895.48, "standard_charge_percentage": 30.0000, "estimated_amount": 4895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 12122.2, "estimated_amount": 12122, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 16318.3, "estimated_amount": 16318, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 16318.3, "estimated_amount": 16318, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8159.14, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3195.12, "standard_charge_percentage": 19.5800, "estimated_amount": 3195, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13054.6, "standard_charge_percentage": 80.0000, "estimated_amount": 13054, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 16318.3, "estimated_amount": 16318, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 16318.3, "estimated_amount": 16318, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 16318.3, "estimated_amount": 16318, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16318.3, "estimated_amount": 16318, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 15910.4, "estimated_amount": 15910, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13054.6, "standard_charge_percentage": 80.0000, "estimated_amount": 13054, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 16318.3, "estimated_amount": 16318, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 16318.3, "estimated_amount": 16318, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27871", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10009.9, "discounted_cash": 19698,"minimum": 1715,"maximum": 10009.9,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1866.85, "standard_charge_percentage": 18.6500, "estimated_amount": 1866, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1904.19, "standard_charge_percentage": 19.0200, "estimated_amount": 1904, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3002.98, "standard_charge_percentage": 30.0000, "estimated_amount": 3002, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 10009.9, "estimated_amount": 10009, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 10009.9, "estimated_amount": 10009, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 10009.9, "estimated_amount": 10009, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 10009.9, "estimated_amount": 10009, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10009.9, "estimated_amount": 10009, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 10009.9, "estimated_amount": 10009, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 10009.9, "estimated_amount": 10009, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8007.94, "standard_charge_percentage": 80.0000, "estimated_amount": 8007, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1959.94, "standard_charge_percentage": 19.5800, "estimated_amount": 1959, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 10009.9, "estimated_amount": 10009, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 10009.9, "estimated_amount": 10009, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5004.96, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5004, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 10009.9, "estimated_amount": 10009, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 10009.9, "estimated_amount": 10009, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 10009.9, "estimated_amount": 10009, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 10009.9, "estimated_amount": 10009, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 10009.9, "estimated_amount": 10009, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8007.94, "standard_charge_percentage": 80.0000, "estimated_amount": 8007, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 10009.9, "estimated_amount": 10009, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 10009.9, "estimated_amount": 10009, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 10009.9, "estimated_amount": 10009, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 10009.9, "estimated_amount": 10009, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 10009.9, "estimated_amount": 10009, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10009.9, "estimated_amount": 10009, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 10009.9, "estimated_amount": 10009, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 10009.9, "estimated_amount": 10009, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 10009.9, "estimated_amount": 10009, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11729.3, "discounted_cash": 367,"minimum": 225.99,"maximum": 9383.46,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2296.6, "standard_charge_percentage": 19.5800, "estimated_amount": 2296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2187.52, "standard_charge_percentage": 18.6500, "estimated_amount": 2187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3518.8, "standard_charge_percentage": 30.0000, "estimated_amount": 3518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5864.66, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5864, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9383.46, "standard_charge_percentage": 80.0000, "estimated_amount": 9383, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2231.27, "standard_charge_percentage": 19.0200, "estimated_amount": 2231, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9383.46, "standard_charge_percentage": 80.0000, "estimated_amount": 9383, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Hc I&D Bursa Foot", "code_information": [ { "code": "28001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3161, "discounted_cash": 2480,"minimum": 589.53,"maximum": 3161,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 589.53, "standard_charge_percentage": 18.6500, "estimated_amount": 589, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 601.32, "standard_charge_percentage": 19.0200, "estimated_amount": 601, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 618.92, "standard_charge_percentage": 19.5800, "estimated_amount": 618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3161, "estimated_amount": 3161, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1580.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1580, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 2478.22, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2478, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3161, "estimated_amount": 3161, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3161, "estimated_amount": 3161, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3161, "estimated_amount": 3161, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3161, "estimated_amount": 3161, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 2478.22, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 2478, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3161, "estimated_amount": 3161, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3161, "estimated_amount": 3161, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2528.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 948.3, "standard_charge_percentage": 30.0000, "estimated_amount": 948, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2528.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3161, "estimated_amount": 3161, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3161, "estimated_amount": 3161, "methodology": "fee schedule" }]}]} , { "description": "Hc I&D Below Fascia Foot, Single", "code_information": [ { "code": "28002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5132, "discounted_cash": 2450,"minimum": 957.12,"maximum": 4415,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4023.49, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4023, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4105.6, "standard_charge_percentage": 80.0000, "estimated_amount": 4105, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1004.85, "standard_charge_percentage": 19.5800, "estimated_amount": 1004, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4105.6, "standard_charge_percentage": 80.0000, "estimated_amount": 4105, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4023.49, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4023, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 957.12, "standard_charge_percentage": 18.6500, "estimated_amount": 957, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2566, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2566, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 976.26, "standard_charge_percentage": 19.0200, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1539.6, "standard_charge_percentage": 30.0000, "estimated_amount": 1539, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" }]}]} , { "description": "Treatment of foot infection", "code_information": [ { "code": "28003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15420.2, "discounted_cash": 4967,"minimum": 1715,"maximum": 12336.2,"payers_information":[{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7710.1, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7710, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2875.87, "standard_charge_percentage": 18.6500, "estimated_amount": 2875, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2933.38, "standard_charge_percentage": 19.0200, "estimated_amount": 2933, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12336.2, "standard_charge_percentage": 80.0000, "estimated_amount": 12336, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4626.06, "standard_charge_percentage": 30.0000, "estimated_amount": 4626, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3019.28, "standard_charge_percentage": 19.5800, "estimated_amount": 3019, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12336.2, "standard_charge_percentage": 80.0000, "estimated_amount": 12336, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6812.08, "discounted_cash": 4967,"minimum": 1270.45,"maximum": 6812.08,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3406.04, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3406, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5449.66, "standard_charge_percentage": 80.0000, "estimated_amount": 5449, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 6812.08, "estimated_amount": 6812, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1270.45, "standard_charge_percentage": 18.6500, "estimated_amount": 1270, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1333.81, "standard_charge_percentage": 19.5800, "estimated_amount": 1333, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6812.08, "estimated_amount": 6812, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6812.08, "estimated_amount": 6812, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1295.86, "standard_charge_percentage": 19.0200, "estimated_amount": 1295, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5449.66, "standard_charge_percentage": 80.0000, "estimated_amount": 5449, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2043.62, "standard_charge_percentage": 30.0000, "estimated_amount": 2043, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 6812.08, "estimated_amount": 6812, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12261.3, "discounted_cash": 4967,"minimum": 1715,"maximum": 9809,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 6130.63, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 6130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2286.72, "standard_charge_percentage": 18.6500, "estimated_amount": 2286, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2332.46, "standard_charge_percentage": 19.0200, "estimated_amount": 2332, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2400.75, "standard_charge_percentage": 19.5800, "estimated_amount": 2400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9809, "standard_charge_percentage": 80.0000, "estimated_amount": 9809, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3678.38, "standard_charge_percentage": 30.0000, "estimated_amount": 3678, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9809, "standard_charge_percentage": 80.0000, "estimated_amount": 9809, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10818.8, "discounted_cash": 2450,"minimum": 1507.78,"maximum": 8655.01,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2017.7, "standard_charge_percentage": 18.6500, "estimated_amount": 2017, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2058.05, "standard_charge_percentage": 19.0200, "estimated_amount": 2058, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3245.63, "standard_charge_percentage": 30.0000, "estimated_amount": 3245, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2118.31, "standard_charge_percentage": 19.5800, "estimated_amount": 2118, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5409.38, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5409, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8655.01, "standard_charge_percentage": 80.0000, "estimated_amount": 8655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8655.01, "standard_charge_percentage": 80.0000, "estimated_amount": 8655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16356.1, "discounted_cash": 4967,"minimum": 1715,"maximum": 13084.9,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13084.9, "standard_charge_percentage": 80.0000, "estimated_amount": 13084, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4906.83, "standard_charge_percentage": 30.0000, "estimated_amount": 4906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3202.52, "standard_charge_percentage": 19.5800, "estimated_amount": 3202, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8178.05, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8178, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3050.41, "standard_charge_percentage": 18.6500, "estimated_amount": 3050, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3111.42, "standard_charge_percentage": 19.0200, "estimated_amount": 3111, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13084.9, "standard_charge_percentage": 80.0000, "estimated_amount": 13084, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10580.6, "discounted_cash": 4967,"minimum": 1715,"maximum": 8464.5,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1973.29, "standard_charge_percentage": 18.6500, "estimated_amount": 1973, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2012.75, "standard_charge_percentage": 19.0200, "estimated_amount": 2012, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8464.5, "standard_charge_percentage": 80.0000, "estimated_amount": 8464, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5290.31, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3174.19, "standard_charge_percentage": 30.0000, "estimated_amount": 3174, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8464.5, "standard_charge_percentage": 80.0000, "estimated_amount": 8464, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2071.69, "standard_charge_percentage": 19.5800, "estimated_amount": 2071, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14640.1, "discounted_cash": 2989,"minimum": 1715,"maximum": 11712,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4392.02, "standard_charge_percentage": 30.0000, "estimated_amount": 4392, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2866.52, "standard_charge_percentage": 19.5800, "estimated_amount": 2866, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2299.69, "estimated_amount": 2299, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1839.75, "estimated_amount": 1839, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3679.5, "estimated_amount": 3679, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4599.38, "estimated_amount": 4599, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 3379.39, "estimated_amount": 3379, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2730.37, "standard_charge_percentage": 18.6500, "estimated_amount": 2730, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 11712, "standard_charge_percentage": 80.0000, "estimated_amount": 11712, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2299.69, "estimated_amount": 2299, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 3104.58, "estimated_amount": 3104, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2299.69, "estimated_amount": 2299, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3957.77, "estimated_amount": 3957, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3219.57, "estimated_amount": 3219, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4875.34, "estimated_amount": 4875, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7320.03, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7320, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 11712, "standard_charge_percentage": 80.0000, "estimated_amount": 11712, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 2299.69, "estimated_amount": 2299, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2299.69, "estimated_amount": 2299, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3957.77, "estimated_amount": 3957, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3957.77, "estimated_amount": 3957, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 2299.69, "estimated_amount": 2299, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 2299.69, "estimated_amount": 2299, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2414.67, "estimated_amount": 2414, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2299.69, "estimated_amount": 2299, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4875.34, "estimated_amount": 4875, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2784.98, "standard_charge_percentage": 19.0200, "estimated_amount": 2784, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 2299.69, "estimated_amount": 2299, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4599.38, "estimated_amount": 4599, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 2299.69, "estimated_amount": 2299, "methodology": "fee schedule" }]}]} , { "description": "Exc foot/toe tum sc 1.5 cm/>", "code_information": [ { "code": "28039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17313.8, "discounted_cash": 4381,"minimum": 1715,"maximum": 13851,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 3539.05, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13851, "standard_charge_percentage": 80.0000, "estimated_amount": 13851, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.2, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3229.02, "standard_charge_percentage": 18.6500, "estimated_amount": 3229, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3293.6, "standard_charge_percentage": 19.0200, "estimated_amount": 3293, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5194.14, "standard_charge_percentage": 30.0000, "estimated_amount": 5194, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3390.04, "standard_charge_percentage": 19.5800, "estimated_amount": 3390, "methodology": "percent of total billed charges" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5392.83, "estimated_amount": 5392, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7145.5, "estimated_amount": 7145, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8656.9, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8656, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13851, "standard_charge_percentage": 80.0000, "estimated_amount": 13851, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2696.42, "estimated_amount": 2696, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3370.52, "estimated_amount": 3370, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5800.66, "estimated_amount": 5800, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4718.73, "estimated_amount": 4718, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6741.04, "estimated_amount": 6741, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4952.98, "estimated_amount": 4952, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11648.5, "discounted_cash": 2480,"minimum": 1526.47,"maximum": 9318.83,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2172.45, "standard_charge_percentage": 18.6500, "estimated_amount": 2172, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2215.9, "standard_charge_percentage": 19.0200, "estimated_amount": 2215, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2280.78, "standard_charge_percentage": 19.5800, "estimated_amount": 2280, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9318.83, "standard_charge_percentage": 80.0000, "estimated_amount": 9318, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5824.27, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5824, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9318.83, "standard_charge_percentage": 80.0000, "estimated_amount": 9318, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3494.56, "standard_charge_percentage": 30.0000, "estimated_amount": 3494, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12576.8, "discounted_cash": 4967,"minimum": 1715,"maximum": 10061.4,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2392.48, "standard_charge_percentage": 19.0200, "estimated_amount": 2392, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10061.4, "standard_charge_percentage": 80.0000, "estimated_amount": 10061, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 6288.4, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 6288, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10061.4, "standard_charge_percentage": 80.0000, "estimated_amount": 10061, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2462.54, "standard_charge_percentage": 19.5800, "estimated_amount": 2462, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2345.57, "standard_charge_percentage": 18.6500, "estimated_amount": 2345, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3773.04, "standard_charge_percentage": 30.0000, "estimated_amount": 3773, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Removal Of Foot Fascia", "code_information": [ { "code": "28062", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25965, "discounted_cash": 4967,"minimum": 1715,"maximum": 20772,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4939.32, "standard_charge_percentage": 19.0200, "estimated_amount": 4939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4842.47, "standard_charge_percentage": 18.6500, "estimated_amount": 4842, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 20772, "standard_charge_percentage": 80.0000, "estimated_amount": 20772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7789.5, "standard_charge_percentage": 30.0000, "estimated_amount": 7789, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 20772, "standard_charge_percentage": 80.0000, "estimated_amount": 20772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5083.95, "standard_charge_percentage": 19.5800, "estimated_amount": 5083, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Removal Of Foot Lesion", "code_information": [ { "code": "28080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26932.5, "discounted_cash": 2450,"minimum": 1507.78,"maximum": 21546,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8079.75, "standard_charge_percentage": 30.0000, "estimated_amount": 8079, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5273.38, "standard_charge_percentage": 19.5800, "estimated_amount": 5273, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5123.37, "standard_charge_percentage": 19.0200, "estimated_amount": 5123, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 21546, "standard_charge_percentage": 80.0000, "estimated_amount": 21546, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 21546, "standard_charge_percentage": 80.0000, "estimated_amount": 21546, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5022.91, "standard_charge_percentage": 18.6500, "estimated_amount": 5022, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" }]}]} , { "description": "Removal of foot lesion", "code_information": [ { "code": "28090", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20437.5, "discounted_cash": 2450,"minimum": 1507.78,"maximum": 16350,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3887.83, "standard_charge_percentage": 19.0200, "estimated_amount": 3887, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 16350, "standard_charge_percentage": 80.0000, "estimated_amount": 16350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3811.59, "standard_charge_percentage": 18.6500, "estimated_amount": 3811, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6131.25, "standard_charge_percentage": 30.0000, "estimated_amount": 6131, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 16350, "standard_charge_percentage": 80.0000, "estimated_amount": 16350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4001.66, "standard_charge_percentage": 19.5800, "estimated_amount": 4001, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28092", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30292.5, "discounted_cash": 2450,"minimum": 1507.78,"maximum": 24234,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5649.55, "standard_charge_percentage": 18.6500, "estimated_amount": 5649, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 24234, "standard_charge_percentage": 80.0000, "estimated_amount": 24234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 24234, "standard_charge_percentage": 80.0000, "estimated_amount": 24234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5762.54, "standard_charge_percentage": 19.0200, "estimated_amount": 5762, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 9087.75, "standard_charge_percentage": 30.0000, "estimated_amount": 9087, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5931.27, "standard_charge_percentage": 19.5800, "estimated_amount": 5931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6025.5, "discounted_cash": 4967,"minimum": 1123.76,"maximum": 6025.5,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3012.75, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3012, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1146.23, "standard_charge_percentage": 19.0200, "estimated_amount": 1146, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4820.4, "standard_charge_percentage": 80.0000, "estimated_amount": 4820, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 6025.5, "estimated_amount": 6025, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1123.76, "standard_charge_percentage": 18.6500, "estimated_amount": 1123, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4820.4, "standard_charge_percentage": 80.0000, "estimated_amount": 4820, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6025.5, "estimated_amount": 6025, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6025.5, "estimated_amount": 6025, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 6025.5, "estimated_amount": 6025, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4723.99, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4723, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4723.99, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4723, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1807.65, "standard_charge_percentage": 30.0000, "estimated_amount": 1807, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1179.79, "standard_charge_percentage": 19.5800, "estimated_amount": 1179, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6025.5, "estimated_amount": 6025, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6025.5, "estimated_amount": 6025, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6025.5, "estimated_amount": 6025, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6025.5, "estimated_amount": 6025, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8034, "discounted_cash": 10936,"minimum": 1498.34,"maximum": 8034,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1498.34, "standard_charge_percentage": 18.6500, "estimated_amount": 1498, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1528.31, "standard_charge_percentage": 19.0200, "estimated_amount": 1528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8034, "estimated_amount": 8034, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 8034, "estimated_amount": 8034, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8034, "estimated_amount": 8034, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 8034, "estimated_amount": 8034, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8034, "estimated_amount": 8034, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6427.2, "standard_charge_percentage": 80.0000, "estimated_amount": 6427, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6427.2, "standard_charge_percentage": 80.0000, "estimated_amount": 6427, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 8034, "estimated_amount": 8034, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8034, "estimated_amount": 8034, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8034, "estimated_amount": 8034, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8034, "estimated_amount": 8034, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4017, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4017, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1573.06, "standard_charge_percentage": 19.5800, "estimated_amount": 1573, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8034, "estimated_amount": 8034, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 8034, "estimated_amount": 8034, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 8034, "estimated_amount": 8034, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 8034, "estimated_amount": 8034, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8034, "estimated_amount": 8034, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2410.2, "standard_charge_percentage": 30.0000, "estimated_amount": 2410, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8034, "estimated_amount": 8034, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8034, "estimated_amount": 8034, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8034, "estimated_amount": 8034, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 8034, "estimated_amount": 8034, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 8034, "estimated_amount": 8034, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8034, "estimated_amount": 8034, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8034, "estimated_amount": 8034, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8034, "estimated_amount": 8034, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28106", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10818.8, "discounted_cash": 10936,"minimum": 1715,"maximum": 10818.8,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2017.7, "standard_charge_percentage": 18.6500, "estimated_amount": 2017, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2058.05, "standard_charge_percentage": 19.0200, "estimated_amount": 2058, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10818.8, "estimated_amount": 10818, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 10818.8, "estimated_amount": 10818, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 10818.8, "estimated_amount": 10818, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 10818.8, "estimated_amount": 10818, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8655, "standard_charge_percentage": 80.0000, "estimated_amount": 8655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3245.63, "standard_charge_percentage": 30.0000, "estimated_amount": 3245, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2118.31, "standard_charge_percentage": 19.5800, "estimated_amount": 2118, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8655, "standard_charge_percentage": 80.0000, "estimated_amount": 8655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 10818.8, "estimated_amount": 10818, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 10818.8, "estimated_amount": 10818, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 10818.8, "estimated_amount": 10818, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 10818.8, "estimated_amount": 10818, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5409.38, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5409, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 10818.8, "estimated_amount": 10818, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 10818.8, "estimated_amount": 10818, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10818.8, "estimated_amount": 10818, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28107", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18752.5, "discounted_cash": 10936,"minimum": 1715,"maximum": 17835.3,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5625.75, "standard_charge_percentage": 30.0000, "estimated_amount": 5625, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3497.34, "standard_charge_percentage": 18.6500, "estimated_amount": 3497, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3567.29, "standard_charge_percentage": 19.0200, "estimated_amount": 3567, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 15002, "standard_charge_percentage": 80.0000, "estimated_amount": 15002, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3671.74, "standard_charge_percentage": 19.5800, "estimated_amount": 3671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 15002, "standard_charge_percentage": 80.0000, "estimated_amount": 15002, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" }]}]} , { "description": "Part removal of metatarsal", "code_information": [ { "code": "28110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 4967,"minimum": 1715,"maximum": 12312,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7032.18, "discounted_cash": 4967,"minimum": 1311.5,"maximum": 7032.18,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1337.73, "standard_charge_percentage": 19.0200, "estimated_amount": 1337, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5625.74, "standard_charge_percentage": 80.0000, "estimated_amount": 5625, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7032.18, "estimated_amount": 7032, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7032.18, "estimated_amount": 7032, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1311.5, "standard_charge_percentage": 18.6500, "estimated_amount": 1311, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5625.74, "standard_charge_percentage": 80.0000, "estimated_amount": 5625, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2109.65, "standard_charge_percentage": 30.0000, "estimated_amount": 2109, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1376.9, "standard_charge_percentage": 19.5800, "estimated_amount": 1376, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7032.18, "estimated_amount": 7032, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7032.18, "estimated_amount": 7032, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3516.09, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3516, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Hc Ostectomy Complete Other Metatarsal Head 2/3/4", "code_information": [ { "code": "28112", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15420.2, "discounted_cash": 4967,"minimum": 1715,"maximum": 12336.2,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2933.38, "standard_charge_percentage": 19.0200, "estimated_amount": 2933, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2875.87, "standard_charge_percentage": 18.6500, "estimated_amount": 2875, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12336.2, "standard_charge_percentage": 80.0000, "estimated_amount": 12336, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3019.28, "standard_charge_percentage": 19.5800, "estimated_amount": 3019, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7710.1, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7710, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12336.2, "standard_charge_percentage": 80.0000, "estimated_amount": 12336, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4626.06, "standard_charge_percentage": 30.0000, "estimated_amount": 4626, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16107.9, "discounted_cash": 4967,"minimum": 1715,"maximum": 12886.3,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3004.13, "standard_charge_percentage": 18.6500, "estimated_amount": 3004, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4832.37, "standard_charge_percentage": 30.0000, "estimated_amount": 4832, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3153.93, "standard_charge_percentage": 19.5800, "estimated_amount": 3153, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12886.3, "standard_charge_percentage": 80.0000, "estimated_amount": 12886, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8053.95, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8053, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3064.21, "standard_charge_percentage": 19.0200, "estimated_amount": 3064, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12886.3, "standard_charge_percentage": 80.0000, "estimated_amount": 12886, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28118", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13625, "discounted_cash": 4967,"minimum": 1715,"maximum": 10900,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 6812.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 6812, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2591.88, "standard_charge_percentage": 19.0200, "estimated_amount": 2591, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10900, "standard_charge_percentage": 80.0000, "estimated_amount": 10900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4087.5, "standard_charge_percentage": 30.0000, "estimated_amount": 4087, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2541.06, "standard_charge_percentage": 18.6500, "estimated_amount": 2541, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10900, "standard_charge_percentage": 80.0000, "estimated_amount": 10900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2667.78, "standard_charge_percentage": 19.5800, "estimated_amount": 2667, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Removal of heel spur", "code_information": [ { "code": "28119", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38947.5, "discounted_cash": 4967,"minimum": 1715,"maximum": 31158,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 7625.92, "standard_charge_percentage": 19.5800, "estimated_amount": 7625, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 7263.71, "standard_charge_percentage": 18.6500, "estimated_amount": 7263, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 7408.98, "standard_charge_percentage": 19.0200, "estimated_amount": 7408, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 31158, "standard_charge_percentage": 80.0000, "estimated_amount": 31158, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 11684.3, "standard_charge_percentage": 30.0000, "estimated_amount": 11684, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 31158, "standard_charge_percentage": 80.0000, "estimated_amount": 31158, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11326.1, "discounted_cash": 4967,"minimum": 1715,"maximum": 9060.9,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2154.57, "standard_charge_percentage": 19.0200, "estimated_amount": 2154, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2217.65, "standard_charge_percentage": 19.5800, "estimated_amount": 2217, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2112.32, "standard_charge_percentage": 18.6500, "estimated_amount": 2112, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3397.84, "standard_charge_percentage": 30.0000, "estimated_amount": 3397, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5663.06, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5663, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9060.9, "standard_charge_percentage": 80.0000, "estimated_amount": 9060, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9060.9, "standard_charge_percentage": 80.0000, "estimated_amount": 9060, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28122", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14324.6, "discounted_cash": 4967,"minimum": 1715,"maximum": 11459.7,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2671.55, "standard_charge_percentage": 18.6500, "estimated_amount": 2671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 11459.7, "standard_charge_percentage": 80.0000, "estimated_amount": 11459, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2724.98, "standard_charge_percentage": 19.0200, "estimated_amount": 2724, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2804.76, "standard_charge_percentage": 19.5800, "estimated_amount": 2804, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7162.32, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7162, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4297.39, "standard_charge_percentage": 30.0000, "estimated_amount": 4297, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 11459.7, "standard_charge_percentage": 80.0000, "estimated_amount": 11459, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Partial removal of toe", "code_information": [ { "code": "28124", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18755, "discounted_cash": 4967,"minimum": 1715,"maximum": 15004,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3497.81, "standard_charge_percentage": 18.6500, "estimated_amount": 3497, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3567.76, "standard_charge_percentage": 19.0200, "estimated_amount": 3567, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 15004, "standard_charge_percentage": 80.0000, "estimated_amount": 15004, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5626.5, "standard_charge_percentage": 30.0000, "estimated_amount": 5626, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3672.23, "standard_charge_percentage": 19.5800, "estimated_amount": 3672, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 15004, "standard_charge_percentage": 80.0000, "estimated_amount": 15004, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28153", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7573.12, "discounted_cash": 4967,"minimum": 1412.39,"maximum": 7573.12,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1440.63, "standard_charge_percentage": 19.0200, "estimated_amount": 1440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6058.5, "standard_charge_percentage": 80.0000, "estimated_amount": 6058, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2271.94, "standard_charge_percentage": 30.0000, "estimated_amount": 2271, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1482.82, "standard_charge_percentage": 19.5800, "estimated_amount": 1482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 7573.12, "estimated_amount": 7573, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6058.5, "standard_charge_percentage": 80.0000, "estimated_amount": 6058, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7573.12, "estimated_amount": 7573, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7573.12, "estimated_amount": 7573, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7573.12, "estimated_amount": 7573, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3786.56, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3786, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1412.39, "standard_charge_percentage": 18.6500, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19237.5, "discounted_cash": 4967,"minimum": 1715,"maximum": 15390,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3587.79, "standard_charge_percentage": 18.6500, "estimated_amount": 3587, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5771.25, "standard_charge_percentage": 30.0000, "estimated_amount": 5771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 15390, "standard_charge_percentage": 80.0000, "estimated_amount": 15390, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3659.55, "standard_charge_percentage": 19.0200, "estimated_amount": 3659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3766.7, "standard_charge_percentage": 19.5800, "estimated_amount": 3766, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 15390, "standard_charge_percentage": 80.0000, "estimated_amount": 15390, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" }]}]} , { "description": "Hc Removal Foot Fb Subq", "code_information": [ { "code": "28190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2159.45, "discounted_cash": 1077,"minimum": 402.74,"maximum": 13848,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 410.79, "standard_charge_percentage": 19.0200, "estimated_amount": 410, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1727.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1727, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3228.32, "standard_charge_percentage": 18.6500, "estimated_amount": 3228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5193, "standard_charge_percentage": 30.0000, "estimated_amount": 5193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1693.01, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1693, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2159.45, "estimated_amount": 2159, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 422.82, "standard_charge_percentage": 19.5800, "estimated_amount": 422, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1727.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1727, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 1325.73, "estimated_amount": 1325, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 1217.6, "estimated_amount": 1217, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2159.45, "estimated_amount": 2159, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1079.72, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1079, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1693.01, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1693, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 402.74, "standard_charge_percentage": 18.6500, "estimated_amount": 402, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 647.83, "standard_charge_percentage": 30.0000, "estimated_amount": 647, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 1118.58, "estimated_amount": 1118, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 662.86, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3292.88, "standard_charge_percentage": 19.0200, "estimated_amount": 3292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3389.3, "standard_charge_percentage": 19.5800, "estimated_amount": 3389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1160.01, "estimated_amount": 1160, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 1657.16, "estimated_amount": 1657, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 870.01, "estimated_amount": 870, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8655, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 1425.99, "estimated_amount": 1425, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 828.58, "estimated_amount": 828, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.59, "estimated_amount": 1756, "methodology": "fee schedule" }]}]} , { "description": "Hc Removal Foot Fb Deep", "code_information": [ { "code": "28192", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5127.07, "discounted_cash": 2480,"minimum": 956.2,"maximum": 4101.66,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1538.12, "standard_charge_percentage": 30.0000, "estimated_amount": 1538, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2563.53, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2563, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 975.32, "standard_charge_percentage": 19.0200, "estimated_amount": 975, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4101.66, "standard_charge_percentage": 80.0000, "estimated_amount": 4101, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4019.62, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4019, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1003.88, "standard_charge_percentage": 19.5800, "estimated_amount": 1003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4019.62, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4019, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 956.2, "standard_charge_percentage": 18.6500, "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4101.66, "standard_charge_percentage": 80.0000, "estimated_amount": 4101, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28193", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5770, "discounted_cash": 2480,"minimum": 1076.1,"maximum": 4616,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4523.68, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4523, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1097.63, "standard_charge_percentage": 19.0200, "estimated_amount": 1097, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2575.92, "estimated_amount": 2575, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2885, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2885, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4523.68, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4523, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4616, "standard_charge_percentage": 80.0000, "estimated_amount": 4616, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2671.33, "estimated_amount": 2671, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2003.49, "estimated_amount": 2003, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4045.15, "estimated_amount": 4045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3147, "estimated_amount": 3147, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1129.77, "standard_charge_percentage": 19.5800, "estimated_amount": 1129, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1526.47, "estimated_amount": 1526, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3283.82, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3816.18, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2803.94, "estimated_amount": 2803, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1076.1, "standard_charge_percentage": 18.6500, "estimated_amount": 1076, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1731, "standard_charge_percentage": 30.0000, "estimated_amount": 1731, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4616, "standard_charge_percentage": 80.0000, "estimated_amount": 4616, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3052.94, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1908.09, "estimated_amount": 1908, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10055.3, "discounted_cash": 4967,"minimum": 1715,"maximum": 8100.6,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5027.67, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5027, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1875.32, "standard_charge_percentage": 18.6500, "estimated_amount": 1875, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1968.84, "standard_charge_percentage": 19.5800, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8044.27, "standard_charge_percentage": 80.0000, "estimated_amount": 8044, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1912.83, "standard_charge_percentage": 19.0200, "estimated_amount": 1912, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8044.27, "standard_charge_percentage": 80.0000, "estimated_amount": 8044, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3016.6, "standard_charge_percentage": 30.0000, "estimated_amount": 3016, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Hc Repair Exten Leg Tendon,Prim,Ea", "code_information": [ { "code": "28208", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9778.3, "discounted_cash": 4967,"minimum": 1715,"maximum": 8100.6,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1823.65, "standard_charge_percentage": 18.6500, "estimated_amount": 1823, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1860.13, "standard_charge_percentage": 19.0200, "estimated_amount": 1860, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2933.49, "standard_charge_percentage": 30.0000, "estimated_amount": 2933, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7822.64, "standard_charge_percentage": 80.0000, "estimated_amount": 7822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1914.59, "standard_charge_percentage": 19.5800, "estimated_amount": 1914, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7822.64, "standard_charge_percentage": 80.0000, "estimated_amount": 7822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4889.15, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Hc Tx Opn Tendon Flexor Foot Single/Mult Tendon Spx", "code_information": [ { "code": "28230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4049, "discounted_cash": 2450,"minimum": 755.14,"maximum": 4049,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4049, "estimated_amount": 4049, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3174.42, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3174, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 755.14, "standard_charge_percentage": 18.6500, "estimated_amount": 755, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 792.79, "standard_charge_percentage": 19.5800, "estimated_amount": 792, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3174.42, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3174, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3239.2, "standard_charge_percentage": 80.0000, "estimated_amount": 3239, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2024.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2024, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3239.2, "standard_charge_percentage": 80.0000, "estimated_amount": 3239, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 770.24, "standard_charge_percentage": 19.0200, "estimated_amount": 770, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1214.7, "standard_charge_percentage": 30.0000, "estimated_amount": 1214, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" }]}]} , { "description": "Hc Incision Flex Toe Tendon", "code_information": [ { "code": "28232", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6961.75, "discounted_cash": 2450,"minimum": 1298.37,"maximum": 5569.4,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1363.11, "standard_charge_percentage": 19.5800, "estimated_amount": 1363, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1298.37, "standard_charge_percentage": 18.6500, "estimated_amount": 1298, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5569.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5569, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2088.53, "standard_charge_percentage": 30.0000, "estimated_amount": 2088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5569.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5569, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3480.88, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3480, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1324.33, "standard_charge_percentage": 19.0200, "estimated_amount": 1324, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" }]}]} , { "description": "Hc Incision Exten Foot/Toe, Ea Tendon", "code_information": [ { "code": "28234", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4895.38, "discounted_cash": 2450,"minimum": 912.99,"maximum": 4415,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1468.61, "standard_charge_percentage": 30.0000, "estimated_amount": 1468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 958.52, "standard_charge_percentage": 19.5800, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 931.25, "standard_charge_percentage": 19.0200, "estimated_amount": 931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2447.69, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2447, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 912.99, "standard_charge_percentage": 18.6500, "estimated_amount": 912, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3837.98, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3916.3, "standard_charge_percentage": 80.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" }]}]} , { "description": "Revision Of Foot Tendon", "code_information": [ { "code": "28238", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30292.5, "discounted_cash": 10936,"minimum": 1715,"maximum": 24234,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 9087.75, "standard_charge_percentage": 30.0000, "estimated_amount": 9087, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5649.55, "standard_charge_percentage": 18.6500, "estimated_amount": 5649, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5931.27, "standard_charge_percentage": 19.5800, "estimated_amount": 5931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 24234, "standard_charge_percentage": 80.0000, "estimated_amount": 24234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 24234, "standard_charge_percentage": 80.0000, "estimated_amount": 24234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5762.54, "standard_charge_percentage": 19.0200, "estimated_amount": 5762, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18572.2, "discounted_cash": 4967,"minimum": 1715,"maximum": 14857.8,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14857.8, "standard_charge_percentage": 80.0000, "estimated_amount": 14857, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3532.99, "standard_charge_percentage": 19.0200, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5571.66, "standard_charge_percentage": 30.0000, "estimated_amount": 5571, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3463.71, "standard_charge_percentage": 18.6500, "estimated_amount": 3463, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3636.43, "standard_charge_percentage": 19.5800, "estimated_amount": 3636, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14857.8, "standard_charge_percentage": 80.0000, "estimated_amount": 14857, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6972.5, "discounted_cash": 4967,"minimum": 1300.37,"maximum": 6972.5,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5578, "standard_charge_percentage": 80.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1365.22, "standard_charge_percentage": 19.5800, "estimated_amount": 1365, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5578, "standard_charge_percentage": 80.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3486.25, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3486, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2091.75, "standard_charge_percentage": 30.0000, "estimated_amount": 2091, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1300.37, "standard_charge_percentage": 18.6500, "estimated_amount": 1300, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1326.38, "standard_charge_percentage": 19.0200, "estimated_amount": 1326, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6972.5, "estimated_amount": 6972, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 6972.5, "estimated_amount": 6972, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6972.5, "estimated_amount": 6972, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 6972.5, "estimated_amount": 6972, "methodology": "fee schedule" }]}]} , { "description": "Hc Repair Of Hammertoe,One", "code_information": [ { "code": "28285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14461.4, "discounted_cash": 4967,"minimum": 1715,"maximum": 15752.6,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2750.99, "standard_charge_percentage": 19.0200, "estimated_amount": 2750, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 15752.6, "standard_charge_percentage": 80.0000, "estimated_amount": 15752, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7230.7, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7230, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 11569.1, "standard_charge_percentage": 80.0000, "estimated_amount": 11569, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4338.42, "standard_charge_percentage": 30.0000, "estimated_amount": 4338, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2831.54, "standard_charge_percentage": 19.5800, "estimated_amount": 2831, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3745.78, "standard_charge_percentage": 19.0200, "estimated_amount": 3745, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3855.46, "standard_charge_percentage": 19.5800, "estimated_amount": 3855, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 15752.6, "standard_charge_percentage": 80.0000, "estimated_amount": 15752, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2697.05, "standard_charge_percentage": 18.6500, "estimated_amount": 2697, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 11569.1, "standard_charge_percentage": 80.0000, "estimated_amount": 11569, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3672.33, "standard_charge_percentage": 18.6500, "estimated_amount": 3672, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5907.24, "standard_charge_percentage": 30.0000, "estimated_amount": 5907, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Partial Removal Of Foot Bone", "code_information": [ { "code": "28288", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17310, "discounted_cash": 4967,"minimum": 1715,"maximum": 13848,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8655, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8655, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3292.88, "standard_charge_percentage": 19.0200, "estimated_amount": 3292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3389.3, "standard_charge_percentage": 19.5800, "estimated_amount": 3389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3228.32, "standard_charge_percentage": 18.6500, "estimated_amount": 3228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5193, "standard_charge_percentage": 30.0000, "estimated_amount": 5193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" }]}]} , { "description": "Corrj Halux Rigdus W/O Implt", "code_information": [ { "code": "28289", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25965, "discounted_cash": 4967,"minimum": 1715,"maximum": 20772,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7789.5, "standard_charge_percentage": 30.0000, "estimated_amount": 7789, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 20772, "standard_charge_percentage": 80.0000, "estimated_amount": 20772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5083.95, "standard_charge_percentage": 19.5800, "estimated_amount": 5083, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 20772, "standard_charge_percentage": 80.0000, "estimated_amount": 20772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4842.47, "standard_charge_percentage": 18.6500, "estimated_amount": 4842, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4939.32, "standard_charge_percentage": 19.0200, "estimated_amount": 4939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12982.5, "discounted_cash": 10936,"minimum": 1715,"maximum": 12982.5,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 12982.5, "estimated_amount": 12982, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 12982.5, "estimated_amount": 12982, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 12982.5, "estimated_amount": 12982, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2541.97, "standard_charge_percentage": 19.5800, "estimated_amount": 2541, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 12982.5, "estimated_amount": 12982, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3894.75, "standard_charge_percentage": 30.0000, "estimated_amount": 3894, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 12982.5, "estimated_amount": 12982, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 12982.5, "estimated_amount": 12982, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 12982.5, "estimated_amount": 12982, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 6491.25, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 6491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2421.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2421, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2469.66, "standard_charge_percentage": 19.0200, "estimated_amount": 2469, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10386, "standard_charge_percentage": 80.0000, "estimated_amount": 10386, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10386, "standard_charge_percentage": 80.0000, "estimated_amount": 10386, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 12982.5, "estimated_amount": 12982, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" }]}]} , { "description": "Cor Hlx Vlgs Rsc Prx Phlx Bs", "code_information": [ { "code": "28292", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25965, "discounted_cash": 4967,"minimum": 1715,"maximum": 20772,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7789.5, "standard_charge_percentage": 30.0000, "estimated_amount": 7789, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5083.95, "standard_charge_percentage": 19.5800, "estimated_amount": 5083, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4939.32, "standard_charge_percentage": 19.0200, "estimated_amount": 4939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 20772, "standard_charge_percentage": 80.0000, "estimated_amount": 20772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 20772, "standard_charge_percentage": 80.0000, "estimated_amount": 20772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4842.47, "standard_charge_percentage": 18.6500, "estimated_amount": 4842, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" }]}]} , { "description": "Cor hlx vlgs dstl mtar osteo", "code_information": [ { "code": "28296", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30292.5, "discounted_cash": 4967,"minimum": 1715,"maximum": 24234,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5649.55, "standard_charge_percentage": 18.6500, "estimated_amount": 5649, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5762.54, "standard_charge_percentage": 19.0200, "estimated_amount": 5762, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5931.27, "standard_charge_percentage": 19.5800, "estimated_amount": 5931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 24234, "standard_charge_percentage": 80.0000, "estimated_amount": 24234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 24234, "standard_charge_percentage": 80.0000, "estimated_amount": 24234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 9087.75, "standard_charge_percentage": 30.0000, "estimated_amount": 9087, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Cor Hlx Vlgs Jt Arthrd", "code_information": [ { "code": "28297", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50487.5, "discounted_cash": 19698,"minimum": 1715,"maximum": 40390,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 15146.3, "standard_charge_percentage": 30.0000, "estimated_amount": 15146, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 40390, "standard_charge_percentage": 80.0000, "estimated_amount": 40390, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 12122.2, "estimated_amount": 12122, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 21213.8, "estimated_amount": 21213, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 40390, "standard_charge_percentage": 80.0000, "estimated_amount": 40390, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 26077.8, "estimated_amount": 26077, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 24244.4, "estimated_amount": 24244, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 22266.9, "estimated_amount": 22266, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 9415.92, "standard_charge_percentage": 18.6500, "estimated_amount": 9415, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 9604.24, "standard_charge_percentage": 19.0200, "estimated_amount": 9604, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 20456.2, "estimated_amount": 20456, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 30305.5, "estimated_amount": 30305, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 30305.5, "estimated_amount": 30305, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 9885.45, "standard_charge_percentage": 19.5800, "estimated_amount": 9885, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 26077.8, "estimated_amount": 26077, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 26077.8, "estimated_amount": 26077, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 15910.4, "estimated_amount": 15910, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 32123.8, "estimated_amount": 32123, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 32123.8, "estimated_amount": 32123, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28298", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24446.3, "discounted_cash": 10936,"minimum": 1715,"maximum": 19557,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4650.41, "standard_charge_percentage": 19.0200, "estimated_amount": 4650, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4559.23, "standard_charge_percentage": 18.6500, "estimated_amount": 4559, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 19557, "standard_charge_percentage": 80.0000, "estimated_amount": 19557, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7333.88, "standard_charge_percentage": 30.0000, "estimated_amount": 7333, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4786.58, "standard_charge_percentage": 19.5800, "estimated_amount": 4786, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 19557, "standard_charge_percentage": 80.0000, "estimated_amount": 19557, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" }]}]} , { "description": "Cor hlx vlgs double osteot", "code_information": [ { "code": "28299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36225, "discounted_cash": 10936,"minimum": 1715,"maximum": 28980,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 6755.96, "standard_charge_percentage": 18.6500, "estimated_amount": 6755, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 6891.08, "standard_charge_percentage": 19.0200, "estimated_amount": 6891, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 28980, "standard_charge_percentage": 80.0000, "estimated_amount": 28980, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 10867.5, "standard_charge_percentage": 30.0000, "estimated_amount": 10867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 7092.85, "standard_charge_percentage": 19.5800, "estimated_amount": 7092, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 28980, "standard_charge_percentage": 80.0000, "estimated_amount": 28980, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9730.52, "discounted_cash": 10936,"minimum": 1715,"maximum": 9730.52,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 9730.52, "estimated_amount": 9730, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9730.52, "estimated_amount": 9730, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1851.04, "standard_charge_percentage": 19.0200, "estimated_amount": 1851, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 9730.52, "estimated_amount": 9730, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7784.42, "standard_charge_percentage": 80.0000, "estimated_amount": 7784, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2919.16, "standard_charge_percentage": 30.0000, "estimated_amount": 2919, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1905.24, "standard_charge_percentage": 19.5800, "estimated_amount": 1905, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7784.42, "standard_charge_percentage": 80.0000, "estimated_amount": 7784, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 9730.52, "estimated_amount": 9730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 9730.52, "estimated_amount": 9730, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 9730.52, "estimated_amount": 9730, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 9730.52, "estimated_amount": 9730, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4865.26, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4865, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1814.74, "standard_charge_percentage": 18.6500, "estimated_amount": 1814, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 9730.52, "estimated_amount": 9730, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 9730.52, "estimated_amount": 9730, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 9730.52, "estimated_amount": 9730, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 9730.52, "estimated_amount": 9730, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28304", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11001.5, "discounted_cash": 10936,"minimum": 1715,"maximum": 11001.5,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3300.44, "standard_charge_percentage": 30.0000, "estimated_amount": 3300, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8801.18, "standard_charge_percentage": 80.0000, "estimated_amount": 8801, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11001.5, "estimated_amount": 11001, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 11001.5, "estimated_amount": 11001, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 11001.5, "estimated_amount": 11001, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5500.73, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5500, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2051.77, "standard_charge_percentage": 18.6500, "estimated_amount": 2051, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2092.81, "standard_charge_percentage": 19.0200, "estimated_amount": 2092, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8801.18, "standard_charge_percentage": 80.0000, "estimated_amount": 8801, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 11001.5, "estimated_amount": 11001, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11001.5, "estimated_amount": 11001, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 11001.5, "estimated_amount": 11001, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 11001.5, "estimated_amount": 11001, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2154.09, "standard_charge_percentage": 19.5800, "estimated_amount": 2154, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 11001.5, "estimated_amount": 11001, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 11001.5, "estimated_amount": 11001, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 11001.5, "estimated_amount": 11001, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 11001.5, "estimated_amount": 11001, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10052.8, "discounted_cash": 10936,"minimum": 1715,"maximum": 10052.8,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1912.33, "standard_charge_percentage": 19.0200, "estimated_amount": 1912, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8042.2, "standard_charge_percentage": 80.0000, "estimated_amount": 8042, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 10052.8, "estimated_amount": 10052, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 10052.8, "estimated_amount": 10052, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10052.8, "estimated_amount": 10052, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 10052.8, "estimated_amount": 10052, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10052.8, "estimated_amount": 10052, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3015.82, "standard_charge_percentage": 30.0000, "estimated_amount": 3015, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 10052.8, "estimated_amount": 10052, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 10052.8, "estimated_amount": 10052, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 10052.8, "estimated_amount": 10052, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8042.2, "standard_charge_percentage": 80.0000, "estimated_amount": 8042, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1968.33, "standard_charge_percentage": 19.5800, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 10052.8, "estimated_amount": 10052, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 10052.8, "estimated_amount": 10052, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5026.38, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5026, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1874.84, "standard_charge_percentage": 18.6500, "estimated_amount": 1874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 10052.8, "estimated_amount": 10052, "methodology": "fee schedule" }]}]} , { "description": "Incision Of Metatarsal", "code_information": [ { "code": "28308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21352.5, "discounted_cash": 4967,"minimum": 1715,"maximum": 17082,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4061.89, "standard_charge_percentage": 19.0200, "estimated_amount": 4061, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3982.24, "standard_charge_percentage": 18.6500, "estimated_amount": 3982, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 17082, "standard_charge_percentage": 80.0000, "estimated_amount": 17082, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6405.75, "standard_charge_percentage": 30.0000, "estimated_amount": 6405, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4180.82, "standard_charge_percentage": 19.5800, "estimated_amount": 4180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 17082, "standard_charge_percentage": 80.0000, "estimated_amount": 17082, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8764.2, "discounted_cash": 10936,"minimum": 1634.52,"maximum": 8764.2,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1667.21, "standard_charge_percentage": 19.0200, "estimated_amount": 1667, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7011.36, "standard_charge_percentage": 80.0000, "estimated_amount": 7011, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2629.26, "standard_charge_percentage": 30.0000, "estimated_amount": 2629, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1716.03, "standard_charge_percentage": 19.5800, "estimated_amount": 1716, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 8764.2, "estimated_amount": 8764, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 8764.2, "estimated_amount": 8764, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 8764.2, "estimated_amount": 8764, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4382.1, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4382, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7011.36, "standard_charge_percentage": 80.0000, "estimated_amount": 7011, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 8764.2, "estimated_amount": 8764, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1634.52, "standard_charge_percentage": 18.6500, "estimated_amount": 1634, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 8764.2, "estimated_amount": 8764, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 8764.2, "estimated_amount": 8764, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 8764.2, "estimated_amount": 8764, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8764.2, "estimated_amount": 8764, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 8764.2, "estimated_amount": 8764, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8764.2, "estimated_amount": 8764, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8764.2, "estimated_amount": 8764, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8764.2, "estimated_amount": 8764, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28315", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6491.25, "discounted_cash": 4967,"minimum": 1210.62,"maximum": 6491.25,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3245.63, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3245, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6491.25, "estimated_amount": 6491, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6491.25, "estimated_amount": 6491, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 6491.25, "estimated_amount": 6491, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5089.14, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5089, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1234.83, "standard_charge_percentage": 19.0200, "estimated_amount": 1234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5193, "standard_charge_percentage": 80.0000, "estimated_amount": 5193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1947.38, "standard_charge_percentage": 30.0000, "estimated_amount": 1947, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5193, "standard_charge_percentage": 80.0000, "estimated_amount": 5193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6491.25, "estimated_amount": 6491, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6491.25, "estimated_amount": 6491, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 6491.25, "estimated_amount": 6491, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5089.14, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5089, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1270.99, "standard_charge_percentage": 19.5800, "estimated_amount": 1270, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6491.25, "estimated_amount": 6491, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1210.62, "standard_charge_percentage": 18.6500, "estimated_amount": 1210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Repair of metatarsals", "code_information": [ { "code": "28322", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34620, "discounted_cash": 10936,"minimum": 1715,"maximum": 27696,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 27696, "standard_charge_percentage": 80.0000, "estimated_amount": 27696, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 6778.6, "standard_charge_percentage": 19.5800, "estimated_amount": 6778, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 27696, "standard_charge_percentage": 80.0000, "estimated_amount": 27696, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 6585.76, "standard_charge_percentage": 19.0200, "estimated_amount": 6585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 6456.63, "standard_charge_percentage": 18.6500, "estimated_amount": 6456, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 10386, "standard_charge_percentage": 30.0000, "estimated_amount": 10386, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Heel Fx Wo Manip", "code_information": [ { "code": "28400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" }]}]} , { "description": "Treat heel fracture", "code_information": [ { "code": "28415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 68166, "discounted_cash": 10936,"minimum": 1715,"maximum": 54532.8,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 13346.9, "standard_charge_percentage": 19.5800, "estimated_amount": 13346, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 12713, "standard_charge_percentage": 18.6500, "estimated_amount": 12712, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 12967.2, "standard_charge_percentage": 19.0200, "estimated_amount": 12967, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 20449.8, "standard_charge_percentage": 30.0000, "estimated_amount": 20449, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 54532.8, "standard_charge_percentage": 80.0000, "estimated_amount": 54532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 54532.8, "standard_charge_percentage": 80.0000, "estimated_amount": 54532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Tarsal Fx Wo Manip Ea", "code_information": [ { "code": "28450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Metatarsal Fx Wo Manip", "code_information": [ { "code": "28470", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" }]}]} , { "description": "Treat metatarsal fracture", "code_information": [ { "code": "28485", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31917, "discounted_cash": 10936,"minimum": 1715,"maximum": 25533.6,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5952.52, "standard_charge_percentage": 18.6500, "estimated_amount": 5952, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 9575.1, "standard_charge_percentage": 30.0000, "estimated_amount": 9575, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 6071.57, "standard_charge_percentage": 19.0200, "estimated_amount": 6071, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 25533.6, "standard_charge_percentage": 80.0000, "estimated_amount": 25533, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 25533.6, "standard_charge_percentage": 80.0000, "estimated_amount": 25533, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 6249.35, "standard_charge_percentage": 19.5800, "estimated_amount": 6249, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Big Toe Fx Wo Manip", "code_information": [ { "code": "28490", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Big Toe Fx W Manip", "code_information": [ { "code": "28495", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1030.95, "discounted_cash": 367,"minimum": 192.27,"maximum": 1030.95,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1030.95, "estimated_amount": 1030, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1030.95, "estimated_amount": 1030, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 201.86, "standard_charge_percentage": 19.5800, "estimated_amount": 201, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 808.26, "standard_charge_percentage": 78.4000, "estimated_amount": 808, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 824.76, "standard_charge_percentage": 80.0000, "estimated_amount": 824, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 876.31, "standard_charge_percentage": 85.0000, "estimated_amount": 876, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 196.12, "standard_charge_percentage": 19.0200, "estimated_amount": 196, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 824.76, "standard_charge_percentage": 80.0000, "estimated_amount": 824, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 309.29, "standard_charge_percentage": 30.0000, "estimated_amount": 309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 192.27, "standard_charge_percentage": 18.6500, "estimated_amount": 192, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 808.26, "standard_charge_percentage": 78.4000, "estimated_amount": 808, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 515.48, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 876.31, "standard_charge_percentage": 85.0000, "estimated_amount": 876, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" }]}]} , { "description": "Treat big toe fracture", "code_information": [ { "code": "28505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19237.5, "discounted_cash": 4967,"minimum": 1715,"maximum": 15390,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3587.79, "standard_charge_percentage": 18.6500, "estimated_amount": 3587, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5771.25, "standard_charge_percentage": 30.0000, "estimated_amount": 5771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3766.7, "standard_charge_percentage": 19.5800, "estimated_amount": 3766, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3659.55, "standard_charge_percentage": 19.0200, "estimated_amount": 3659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 15390, "standard_charge_percentage": 80.0000, "estimated_amount": 15390, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 15390, "standard_charge_percentage": 80.0000, "estimated_amount": 15390, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Toe Fx Wo Manip Ea", "code_information": [ { "code": "28510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Toe Fx W Manip Ea", "code_information": [ { "code": "28515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 968.12, "discounted_cash": 367,"minimum": 180.55,"maximum": 12312,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 822.9, "standard_charge_percentage": 85.0000, "estimated_amount": 822, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 184.17, "standard_charge_percentage": 19.0200, "estimated_amount": 184, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 774.5, "standard_charge_percentage": 80.0000, "estimated_amount": 774, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 759.01, "standard_charge_percentage": 78.4000, "estimated_amount": 759, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 759.01, "standard_charge_percentage": 78.4000, "estimated_amount": 759, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 968.12, "estimated_amount": 968, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 774.5, "standard_charge_percentage": 80.0000, "estimated_amount": 774, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 822.9, "standard_charge_percentage": 85.0000, "estimated_amount": 822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 290.44, "standard_charge_percentage": 30.0000, "estimated_amount": 290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 968.12, "estimated_amount": 968, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 484.06, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 180.55, "standard_charge_percentage": 18.6500, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 189.56, "standard_charge_percentage": 19.5800, "estimated_amount": 189, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5770, "discounted_cash": 4967,"minimum": 1076.1,"maximum": 5770,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2885, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2885, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4523.68, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4523, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4616, "standard_charge_percentage": 80.0000, "estimated_amount": 4616, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4523.68, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4523, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1097.63, "standard_charge_percentage": 19.0200, "estimated_amount": 1097, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1076.1, "standard_charge_percentage": 18.6500, "estimated_amount": 1076, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1731, "standard_charge_percentage": 30.0000, "estimated_amount": 1731, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4616, "standard_charge_percentage": 80.0000, "estimated_amount": 4616, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1129.77, "standard_charge_percentage": 19.5800, "estimated_amount": 1129, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Tarsal Disloc Wo Anes", "code_information": [ { "code": "28540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1052.5, "discounted_cash": 367,"minimum": 196.29,"maximum": 1052.5,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1052.5, "estimated_amount": 1052, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 196.29, "standard_charge_percentage": 18.6500, "estimated_amount": 196, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 526.25, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 526, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 894.63, "standard_charge_percentage": 85.0000, "estimated_amount": 894, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 200.22, "standard_charge_percentage": 19.0200, "estimated_amount": 200, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 842, "standard_charge_percentage": 80.0000, "estimated_amount": 842, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 315.75, "standard_charge_percentage": 30.0000, "estimated_amount": 315, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 842, "standard_charge_percentage": 80.0000, "estimated_amount": 842, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1052.5, "estimated_amount": 1052, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 825.16, "standard_charge_percentage": 78.4000, "estimated_amount": 825, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 894.63, "standard_charge_percentage": 85.0000, "estimated_amount": 894, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 206.08, "standard_charge_percentage": 19.5800, "estimated_amount": 206, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 825.16, "standard_charge_percentage": 78.4000, "estimated_amount": 825, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11198.7, "discounted_cash": 10936,"minimum": 1715,"maximum": 11198.7,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2088.56, "standard_charge_percentage": 18.6500, "estimated_amount": 2088, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2130.33, "standard_charge_percentage": 19.0200, "estimated_amount": 2130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3359.61, "standard_charge_percentage": 30.0000, "estimated_amount": 3359, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2192.71, "standard_charge_percentage": 19.5800, "estimated_amount": 2192, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 11198.7, "estimated_amount": 11198, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11198.7, "estimated_amount": 11198, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 11198.7, "estimated_amount": 11198, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 11198.7, "estimated_amount": 11198, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8958.96, "standard_charge_percentage": 80.0000, "estimated_amount": 8958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 11198.7, "estimated_amount": 11198, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 11198.7, "estimated_amount": 11198, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11198.7, "estimated_amount": 11198, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 11198.7, "estimated_amount": 11198, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 11198.7, "estimated_amount": 11198, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 11198.7, "estimated_amount": 11198, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5599.35, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5599, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8958.96, "standard_charge_percentage": 80.0000, "estimated_amount": 8958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 11198.7, "estimated_amount": 11198, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Talotarsal Disloc W Anes", "code_information": [ { "code": "28570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1030.95, "discounted_cash": 367,"minimum": 192.27,"maximum": 1030.95,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 515.48, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 876.31, "standard_charge_percentage": 85.0000, "estimated_amount": 876, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 192.27, "standard_charge_percentage": 18.6500, "estimated_amount": 192, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 824.76, "standard_charge_percentage": 80.0000, "estimated_amount": 824, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 808.26, "standard_charge_percentage": 78.4000, "estimated_amount": 808, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1030.95, "estimated_amount": 1030, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 196.12, "standard_charge_percentage": 19.0200, "estimated_amount": 196, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 309.29, "standard_charge_percentage": 30.0000, "estimated_amount": 309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 201.86, "standard_charge_percentage": 19.5800, "estimated_amount": 201, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1030.95, "estimated_amount": 1030, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 876.31, "standard_charge_percentage": 85.0000, "estimated_amount": 876, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 808.26, "standard_charge_percentage": 78.4000, "estimated_amount": 808, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 824.76, "standard_charge_percentage": 80.0000, "estimated_amount": 824, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28585", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13722.5, "discounted_cash": 10936,"minimum": 1715,"maximum": 13722.5,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2686.87, "standard_charge_percentage": 19.5800, "estimated_amount": 2686, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10978, "standard_charge_percentage": 80.0000, "estimated_amount": 10978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 13722.5, "estimated_amount": 13722, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 13722.5, "estimated_amount": 13722, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 13722.5, "estimated_amount": 13722, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 13722.5, "estimated_amount": 13722, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 6861.26, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 6861, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2610.43, "standard_charge_percentage": 19.0200, "estimated_amount": 2610, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 13722.5, "estimated_amount": 13722, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 13722.5, "estimated_amount": 13722, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2559.25, "standard_charge_percentage": 18.6500, "estimated_amount": 2559, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10978, "standard_charge_percentage": 80.0000, "estimated_amount": 10978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4116.75, "standard_charge_percentage": 30.0000, "estimated_amount": 4116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 13722.5, "estimated_amount": 13722, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14029.1, "discounted_cash": 10936,"minimum": 1715,"maximum": 14029.1,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14029.1, "estimated_amount": 14029, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 14029.1, "estimated_amount": 14029, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7014.55, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7014, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 11223.3, "standard_charge_percentage": 80.0000, "estimated_amount": 11223, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2746.9, "standard_charge_percentage": 19.5800, "estimated_amount": 2746, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14029.1, "estimated_amount": 14029, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2616.43, "standard_charge_percentage": 18.6500, "estimated_amount": 2616, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4208.73, "standard_charge_percentage": 30.0000, "estimated_amount": 4208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 14029.1, "estimated_amount": 14029, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2668.76, "standard_charge_percentage": 19.0200, "estimated_amount": 2668, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 11223.3, "standard_charge_percentage": 80.0000, "estimated_amount": 11223, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14029.1, "estimated_amount": 14029, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 14029.1, "estimated_amount": 14029, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 14029.1, "estimated_amount": 14029, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Mt-Phal Toe Disloc Wo Anes", "code_information": [ { "code": "28630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28645", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10097.5, "discounted_cash": 4967,"minimum": 1715,"maximum": 8100.6,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1883.18, "standard_charge_percentage": 18.6500, "estimated_amount": 1883, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8078, "standard_charge_percentage": 80.0000, "estimated_amount": 8078, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5048.75, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5048, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8078, "standard_charge_percentage": 80.0000, "estimated_amount": 8078, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3029.25, "standard_charge_percentage": 30.0000, "estimated_amount": 3029, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1977.09, "standard_charge_percentage": 19.5800, "estimated_amount": 1977, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1920.85, "standard_charge_percentage": 19.0200, "estimated_amount": 1920, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat I-P Jt,Toe Disloc Wo Anes", "code_information": [ { "code": "28660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 367,"minimum": 156.48,"maximum": 839.01,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 159.6, "standard_charge_percentage": 19.0200, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 164.28, "standard_charge_percentage": 19.5800, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 657.78, "standard_charge_percentage": 78.4000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 419.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 251.7, "standard_charge_percentage": 30.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 839.01, "estimated_amount": 839, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 156.48, "standard_charge_percentage": 18.6500, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 713.16, "standard_charge_percentage": 85.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 671.21, "standard_charge_percentage": 80.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Repair Of Toe Dislocation", "code_information": [ { "code": "28675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21637.5, "discounted_cash": 4967,"minimum": 1715,"maximum": 17310,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 17310, "standard_charge_percentage": 80.0000, "estimated_amount": 17310, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6491.25, "standard_charge_percentage": 30.0000, "estimated_amount": 6491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4116.1, "standard_charge_percentage": 19.0200, "estimated_amount": 4116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4236.62, "standard_charge_percentage": 19.5800, "estimated_amount": 4236, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4035.39, "standard_charge_percentage": 18.6500, "estimated_amount": 4035, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 17310, "standard_charge_percentage": 80.0000, "estimated_amount": 17310, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16588.8, "discounted_cash": 28154,"minimum": 1715,"maximum": 16588.8,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3155.68, "standard_charge_percentage": 19.0200, "estimated_amount": 3155, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13271, "standard_charge_percentage": 80.0000, "estimated_amount": 13271, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4976.63, "standard_charge_percentage": 30.0000, "estimated_amount": 4976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3248.08, "standard_charge_percentage": 19.5800, "estimated_amount": 3248, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 16588.8, "estimated_amount": 16588, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 16588.8, "estimated_amount": 16588, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 16588.8, "estimated_amount": 16588, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 16588.8, "estimated_amount": 16588, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 16588.8, "estimated_amount": 16588, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 16588.8, "estimated_amount": 16588, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 16588.8, "estimated_amount": 16588, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 16588.8, "estimated_amount": 16588, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8294.38, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8294, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3093.8, "standard_charge_percentage": 18.6500, "estimated_amount": 3093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13271, "standard_charge_percentage": 80.0000, "estimated_amount": 13271, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 16588.8, "estimated_amount": 16588, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 16588.8, "estimated_amount": 16588, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 16588.8, "estimated_amount": 16588, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 16588.8, "estimated_amount": 16588, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16588.8, "estimated_amount": 16588, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 16588.8, "estimated_amount": 16588, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 16588.8, "estimated_amount": 16588, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 16588.8, "estimated_amount": 16588, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 16588.8, "estimated_amount": 16588, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 16588.8, "estimated_amount": 16588, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 16588.8, "estimated_amount": 16588, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 16588.8, "estimated_amount": 16588, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16588.8, "estimated_amount": 16588, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 16588.8, "estimated_amount": 16588, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 16588.8, "estimated_amount": 16588, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28715", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13832.5, "discounted_cash": 19698,"minimum": 1715,"maximum": 13832.5,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 6916.27, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 6916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2579.77, "standard_charge_percentage": 18.6500, "estimated_amount": 2579, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13832.5, "estimated_amount": 13832, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 12122.2, "estimated_amount": 12122, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 13832.5, "estimated_amount": 13832, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 13832.5, "estimated_amount": 13832, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 13832.5, "estimated_amount": 13832, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 13832.5, "estimated_amount": 13832, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 13832.5, "estimated_amount": 13832, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 13832.5, "estimated_amount": 13832, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2708.41, "standard_charge_percentage": 19.5800, "estimated_amount": 2708, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 13832.5, "estimated_amount": 13832, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 13832.5, "estimated_amount": 13832, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 13832.5, "estimated_amount": 13832, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13832.5, "estimated_amount": 13832, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 13832.5, "estimated_amount": 13832, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 13832.5, "estimated_amount": 13832, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 11066, "standard_charge_percentage": 80.0000, "estimated_amount": 11066, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4149.76, "standard_charge_percentage": 30.0000, "estimated_amount": 4149, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 11066, "standard_charge_percentage": 80.0000, "estimated_amount": 11066, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 13832.5, "estimated_amount": 13832, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13832.5, "estimated_amount": 13832, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 13832.5, "estimated_amount": 13832, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 13832.5, "estimated_amount": 13832, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2631.36, "standard_charge_percentage": 19.0200, "estimated_amount": 2631, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 13832.5, "estimated_amount": 13832, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 13832.5, "estimated_amount": 13832, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 13832.5, "estimated_amount": 13832, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 13832.5, "estimated_amount": 13832, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 13832.5, "estimated_amount": 13832, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11186.1, "discounted_cash": 19698,"minimum": 1715,"maximum": 11186.1,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5593.06, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 11186.1, "estimated_amount": 11186, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 11186.1, "estimated_amount": 11186, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 11186.1, "estimated_amount": 11186, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 11186.1, "estimated_amount": 11186, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 11186.1, "estimated_amount": 11186, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2086.21, "standard_charge_percentage": 18.6500, "estimated_amount": 2086, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3355.83, "standard_charge_percentage": 30.0000, "estimated_amount": 3355, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2190.24, "standard_charge_percentage": 19.5800, "estimated_amount": 2190, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8948.89, "standard_charge_percentage": 80.0000, "estimated_amount": 8948, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11186.1, "estimated_amount": 11186, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 11186.1, "estimated_amount": 11186, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11186.1, "estimated_amount": 11186, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 11186.1, "estimated_amount": 11186, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 11186.1, "estimated_amount": 11186, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 11186.1, "estimated_amount": 11186, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 11186.1, "estimated_amount": 11186, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 11186.1, "estimated_amount": 11186, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 11186.1, "estimated_amount": 11186, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 11186.1, "estimated_amount": 11186, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 11186.1, "estimated_amount": 11186, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 11186.1, "estimated_amount": 11186, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2127.93, "standard_charge_percentage": 19.0200, "estimated_amount": 2127, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8948.89, "standard_charge_percentage": 80.0000, "estimated_amount": 8948, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 11186.1, "estimated_amount": 11186, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 11186.1, "estimated_amount": 11186, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 11186.1, "estimated_amount": 11186, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 11186.1, "estimated_amount": 11186, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 11186.1, "estimated_amount": 11186, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 11186.1, "estimated_amount": 11186, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16889, "discounted_cash": 19698,"minimum": 1715,"maximum": 16889,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13511.2, "standard_charge_percentage": 80.0000, "estimated_amount": 13511, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 12122.2, "estimated_amount": 12122, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 16889, "estimated_amount": 16888, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16889, "estimated_amount": 16888, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 16889, "estimated_amount": 16888, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3149.79, "standard_charge_percentage": 18.6500, "estimated_amount": 3149, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3212.78, "standard_charge_percentage": 19.0200, "estimated_amount": 3212, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13511.2, "standard_charge_percentage": 80.0000, "estimated_amount": 13511, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 16889, "estimated_amount": 16888, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8444.48, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8444, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3306.86, "standard_charge_percentage": 19.5800, "estimated_amount": 3306, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 16889, "estimated_amount": 16888, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 16889, "estimated_amount": 16888, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 16889, "estimated_amount": 16888, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5066.69, "standard_charge_percentage": 30.0000, "estimated_amount": 5066, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 16889, "estimated_amount": 16888, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 16889, "estimated_amount": 16888, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16889, "estimated_amount": 16888, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 15910.4, "estimated_amount": 15910, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 16889, "estimated_amount": 16888, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23620.9, "discounted_cash": 19698,"minimum": 1715,"maximum": 23620.9,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4493.41, "standard_charge_percentage": 19.0200, "estimated_amount": 4493, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7086.28, "standard_charge_percentage": 30.0000, "estimated_amount": 7086, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 18896.8, "standard_charge_percentage": 80.0000, "estimated_amount": 18896, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 23620.9, "estimated_amount": 23620, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 23620.9, "estimated_amount": 23620, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 23620.9, "estimated_amount": 23620, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 23620.9, "estimated_amount": 23620, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 21213.8, "estimated_amount": 21213, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 23620.9, "estimated_amount": 23620, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 23620.9, "estimated_amount": 23620, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 12122.2, "estimated_amount": 12122, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 23620.9, "estimated_amount": 23620, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 23620.9, "estimated_amount": 23620, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 22266.9, "estimated_amount": 22266, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 15910.4, "estimated_amount": 15910, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4405.31, "standard_charge_percentage": 18.6500, "estimated_amount": 4405, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 18896.8, "standard_charge_percentage": 80.0000, "estimated_amount": 18896, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4624.98, "standard_charge_percentage": 19.5800, "estimated_amount": 4624, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 20456.2, "estimated_amount": 20456, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 15152.7, "estimated_amount": 15152, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28737", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13466.3, "discounted_cash": 19698,"minimum": 1715,"maximum": 13466.3,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 6733.13, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 6733, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10773, "standard_charge_percentage": 80.0000, "estimated_amount": 10773, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4039.88, "standard_charge_percentage": 30.0000, "estimated_amount": 4039, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 13466.3, "estimated_amount": 13466, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 13466.3, "estimated_amount": 13466, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 12122.2, "estimated_amount": 12122, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13466.3, "estimated_amount": 13466, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 13466.3, "estimated_amount": 13466, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 13466.3, "estimated_amount": 13466, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 13466.3, "estimated_amount": 13466, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 13466.3, "estimated_amount": 13466, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 13466.3, "estimated_amount": 13466, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2561.68, "standard_charge_percentage": 19.0200, "estimated_amount": 2561, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 13466.3, "estimated_amount": 13466, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13466.3, "estimated_amount": 13466, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 13466.3, "estimated_amount": 13466, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 13466.3, "estimated_amount": 13466, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 13466.3, "estimated_amount": 13466, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 13466.3, "estimated_amount": 13466, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2511.46, "standard_charge_percentage": 18.6500, "estimated_amount": 2511, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2636.69, "standard_charge_percentage": 19.5800, "estimated_amount": 2636, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13466.3, "estimated_amount": 13466, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 13466.3, "estimated_amount": 13466, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 13466.3, "estimated_amount": 13466, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 13466.3, "estimated_amount": 13466, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 13466.3, "estimated_amount": 13466, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10773, "standard_charge_percentage": 80.0000, "estimated_amount": 10773, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 13466.3, "estimated_amount": 13466, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 13466.3, "estimated_amount": 13466, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 13466.3, "estimated_amount": 13466, "methodology": "fee schedule" }]}]} , { "description": "Fusion of foot bones", "code_information": [ { "code": "28740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43275, "discounted_cash": 10936,"minimum": 1715,"maximum": 34620,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 8232.2, "standard_charge_percentage": 19.0200, "estimated_amount": 8232, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 34620, "standard_charge_percentage": 80.0000, "estimated_amount": 34620, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 8070.79, "standard_charge_percentage": 18.6500, "estimated_amount": 8070, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 34620, "standard_charge_percentage": 80.0000, "estimated_amount": 34620, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12982.5, "standard_charge_percentage": 30.0000, "estimated_amount": 12982, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 8473.24, "standard_charge_percentage": 19.5800, "estimated_amount": 8473, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" }]}]} , { "description": "Fusion Of Big Toe Joint", "code_information": [ { "code": "28750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36411.4, "discounted_cash": 10936,"minimum": 1715,"maximum": 29129.1,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 6790.73, "standard_charge_percentage": 18.6500, "estimated_amount": 6790, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 29129.1, "standard_charge_percentage": 80.0000, "estimated_amount": 29129, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 6926.54, "standard_charge_percentage": 19.0200, "estimated_amount": 6926, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 29129.1, "standard_charge_percentage": 80.0000, "estimated_amount": 29129, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 10923.4, "standard_charge_percentage": 30.0000, "estimated_amount": 10923, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 7129.35, "standard_charge_percentage": 19.5800, "estimated_amount": 7129, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28755", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8384.53, "discounted_cash": 10936,"minimum": 1563.71,"maximum": 8384.53,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1641.69, "standard_charge_percentage": 19.5800, "estimated_amount": 1641, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8384.53, "estimated_amount": 8384, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8384.53, "estimated_amount": 8384, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8384.53, "estimated_amount": 8384, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8384.53, "estimated_amount": 8384, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8384.53, "estimated_amount": 8384, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1594.99, "standard_charge_percentage": 19.0200, "estimated_amount": 1594, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6707.62, "standard_charge_percentage": 80.0000, "estimated_amount": 6707, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2515.36, "standard_charge_percentage": 30.0000, "estimated_amount": 2515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 8384.53, "estimated_amount": 8384, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 8384.53, "estimated_amount": 8384, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8384.53, "estimated_amount": 8384, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8384.53, "estimated_amount": 8384, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1563.71, "standard_charge_percentage": 18.6500, "estimated_amount": 1563, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8384.53, "estimated_amount": 8384, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8384.53, "estimated_amount": 8384, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8384.53, "estimated_amount": 8384, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 8384.53, "estimated_amount": 8384, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8384.53, "estimated_amount": 8384, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4192.27, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4192, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6707.62, "standard_charge_percentage": 80.0000, "estimated_amount": 6707, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 8384.53, "estimated_amount": 8384, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8384.53, "estimated_amount": 8384, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8384.53, "estimated_amount": 8384, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 8384.53, "estimated_amount": 8384, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 8384.53, "estimated_amount": 8384, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 8384.53, "estimated_amount": 8384, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 8384.53, "estimated_amount": 8384, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8384.53, "estimated_amount": 8384, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28760", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12172.5, "discounted_cash": 10936,"minimum": 1715,"maximum": 12172.5,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2315.57, "standard_charge_percentage": 19.0200, "estimated_amount": 2315, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2383.38, "standard_charge_percentage": 19.5800, "estimated_amount": 2383, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 12172.5, "estimated_amount": 12172, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 12172.5, "estimated_amount": 12172, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 12172.5, "estimated_amount": 12172, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 12172.5, "estimated_amount": 12172, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12172.5, "estimated_amount": 12172, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 6086.25, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 6086, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2270.17, "standard_charge_percentage": 18.6500, "estimated_amount": 2270, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3651.75, "standard_charge_percentage": 30.0000, "estimated_amount": 3651, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9738, "standard_charge_percentage": 80.0000, "estimated_amount": 9738, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9738, "standard_charge_percentage": 80.0000, "estimated_amount": 9738, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 12172.5, "estimated_amount": 12172, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 12172.5, "estimated_amount": 12172, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 12172.5, "estimated_amount": 12172, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 12172.5, "estimated_amount": 12172, "methodology": "fee schedule" }]}]} , { "description": "Amputation Toe & Metatarsal", "code_information": [ { "code": "28810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30292.5, "discounted_cash": 4967,"minimum": 1715,"maximum": 24234,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 24234, "standard_charge_percentage": 80.0000, "estimated_amount": 24234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 24234, "standard_charge_percentage": 80.0000, "estimated_amount": 24234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5762.54, "standard_charge_percentage": 19.0200, "estimated_amount": 5762, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5649.55, "standard_charge_percentage": 18.6500, "estimated_amount": 5649, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 9087.75, "standard_charge_percentage": 30.0000, "estimated_amount": 9087, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5931.27, "standard_charge_percentage": 19.5800, "estimated_amount": 5931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8114.06, "discounted_cash": 4967,"minimum": 1513.27,"maximum": 8100.6,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1588.73, "standard_charge_percentage": 19.5800, "estimated_amount": 1588, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6491.25, "standard_charge_percentage": 80.0000, "estimated_amount": 6491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1513.27, "standard_charge_percentage": 18.6500, "estimated_amount": 1513, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6491.25, "standard_charge_percentage": 80.0000, "estimated_amount": 6491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4057.03, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4057, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1543.54, "standard_charge_percentage": 19.0200, "estimated_amount": 1543, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2434.22, "standard_charge_percentage": 30.0000, "estimated_amount": 2434, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Hc Amputation Toe Interphalangeal Joint", "code_information": [ { "code": "28825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16223, "discounted_cash": 4967,"minimum": 1715,"maximum": 14425,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12978.4, "standard_charge_percentage": 80.0000, "estimated_amount": 12978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9015.65, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9015, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3362.84, "standard_charge_percentage": 18.6500, "estimated_amount": 3362, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5409.39, "standard_charge_percentage": 30.0000, "estimated_amount": 5409, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3176.46, "standard_charge_percentage": 19.5800, "estimated_amount": 3176, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4866.9, "standard_charge_percentage": 30.0000, "estimated_amount": 4866, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3430.09, "standard_charge_percentage": 19.0200, "estimated_amount": 3430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14425, "standard_charge_percentage": 80.0000, "estimated_amount": 14425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8111.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8111, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3025.59, "standard_charge_percentage": 18.6500, "estimated_amount": 3025, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3086.1, "standard_charge_percentage": 19.0200, "estimated_amount": 3086, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12978.4, "standard_charge_percentage": 80.0000, "estimated_amount": 12978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14425, "standard_charge_percentage": 80.0000, "estimated_amount": 14425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3530.53, "standard_charge_percentage": 19.5800, "estimated_amount": 3530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8114.06, "discounted_cash": 367,"minimum": 225.99,"maximum": 6491.25,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6491.25, "standard_charge_percentage": 80.0000, "estimated_amount": 6491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4057.03, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4057, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1543.54, "standard_charge_percentage": 19.0200, "estimated_amount": 1543, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1588.73, "standard_charge_percentage": 19.5800, "estimated_amount": 1588, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6491.25, "standard_charge_percentage": 80.0000, "estimated_amount": 6491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1513.27, "standard_charge_percentage": 18.6500, "estimated_amount": 1513, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2434.22, "standard_charge_percentage": 30.0000, "estimated_amount": 2434, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" }]}]} , { "description": "Hc Apply Elbow To Finger Cast", "code_information": [ { "code": "29075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1199.55, "discounted_cash": 406,"minimum": 223.72,"maximum": 1199.55,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1019.62, "standard_charge_percentage": 85.0000, "estimated_amount": 1019, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 228.19, "standard_charge_percentage": 19.0200, "estimated_amount": 228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 359.87, "standard_charge_percentage": 30.0000, "estimated_amount": 359, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 250.21, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 437.86, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 625.52, "estimated_amount": 625, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 459.6, "estimated_amount": 459, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1199.55, "estimated_amount": 1199, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1199.55, "estimated_amount": 1199, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 599.77, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 599, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 223.72, "standard_charge_percentage": 18.6500, "estimated_amount": 223, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1019.62, "standard_charge_percentage": 85.0000, "estimated_amount": 1019, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 940.45, "standard_charge_percentage": 78.4000, "estimated_amount": 940, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 328.4, "estimated_amount": 328, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 663.05, "estimated_amount": 663, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 663.05, "estimated_amount": 663, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 959.64, "standard_charge_percentage": 80.0000, "estimated_amount": 959, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 234.87, "standard_charge_percentage": 19.5800, "estimated_amount": 234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 959.64, "standard_charge_percentage": 80.0000, "estimated_amount": 959, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 538.26, "estimated_amount": 538, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 500.42, "estimated_amount": 500, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 940.45, "standard_charge_percentage": 78.4000, "estimated_amount": 940, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 422.23, "estimated_amount": 422, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 538.26, "estimated_amount": 538, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 538.26, "estimated_amount": 538, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 625.52, "estimated_amount": 625, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" }]}]} , { "description": "Hc Application Cast Finger", "code_information": [ { "code": "29086", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320, "discounted_cash": 241,"minimum": 59.68,"maximum": 320,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 320, "estimated_amount": 320, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 60.87, "standard_charge_percentage": 19.0200, "estimated_amount": 60, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 319.8, "estimated_amount": 319, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 320, "estimated_amount": 320, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 273.06, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 195.11, "estimated_amount": 195, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 320, "estimated_amount": 320, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 297.31, "estimated_amount": 297, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 320, "estimated_amount": 320, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 320, "estimated_amount": 320, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 250.88, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 256, "standard_charge_percentage": 80.0000, "estimated_amount": 256, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 96, "standard_charge_percentage": 30.0000, "estimated_amount": 96, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 62.66, "standard_charge_percentage": 19.5800, "estimated_amount": 62, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 148.66, "estimated_amount": 148, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 260.15, "estimated_amount": 260, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 320, "estimated_amount": 320, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 320, "estimated_amount": 320, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 160, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 250.88, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 59.68, "standard_charge_percentage": 18.6500, "estimated_amount": 59, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 256, "standard_charge_percentage": 80.0000, "estimated_amount": 256, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 250.86, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 319.8, "estimated_amount": 319, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 319.8, "estimated_amount": 319, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 320, "estimated_amount": 320, "methodology": "fee schedule" }]}]} , { "description": "Hc Apply Long Arm Splint", "code_information": [ { "code": "29105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 646.85, "discounted_cash": 241,"minimum": 120.64,"maximum": 646.85,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 323.43, "standard_charge_percentage": 50.0000, "estimated_amount": 323, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 250.86, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 260.15, "estimated_amount": 260, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 393.94, "estimated_amount": 393, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 646.85, "estimated_amount": 646, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 549.82, "standard_charge_percentage": 85.0000, "estimated_amount": 549, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 517.48, "standard_charge_percentage": 80.0000, "estimated_amount": 517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 507.13, "standard_charge_percentage": 78.4000, "estimated_amount": 507, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 507.13, "standard_charge_percentage": 78.4000, "estimated_amount": 507, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 148.66, "estimated_amount": 148, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 319.8, "estimated_amount": 319, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 319.8, "estimated_amount": 319, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 273.06, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 195.11, "estimated_amount": 195, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 646.85, "estimated_amount": 646, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 194.06, "standard_charge_percentage": 30.0000, "estimated_amount": 194, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 126.65, "standard_charge_percentage": 19.5800, "estimated_amount": 126, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 297.31, "estimated_amount": 297, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 393.94, "estimated_amount": 393, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 120.64, "standard_charge_percentage": 18.6500, "estimated_amount": 120, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 549.82, "standard_charge_percentage": 85.0000, "estimated_amount": 549, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 123.05, "standard_charge_percentage": 19.0200, "estimated_amount": 123, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 517.48, "standard_charge_percentage": 80.0000, "estimated_amount": 517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 319.8, "estimated_amount": 319, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 371.64, "estimated_amount": 371, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 371.64, "estimated_amount": 371, "methodology": "fee schedule" }]}]} , { "description": "Hc Apply Forearm Splint Static", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 524.41, "discounted_cash": 197,"minimum": 97.8,"maximum": 524.41,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 524.41, "estimated_amount": 524, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 262.2, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 262, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 445.75, "standard_charge_percentage": 85.0000, "estimated_amount": 445, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 99.76, "standard_charge_percentage": 19.0200, "estimated_amount": 99, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 204.93, "estimated_amount": 204, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 97.8, "standard_charge_percentage": 18.6500, "estimated_amount": 97, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 419.53, "standard_charge_percentage": 80.0000, "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 223.07, "estimated_amount": 223, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 321.82, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 445.75, "standard_charge_percentage": 85.0000, "estimated_amount": 445, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 157.32, "standard_charge_percentage": 30.0000, "estimated_amount": 157, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 102.68, "standard_charge_percentage": 19.5800, "estimated_amount": 102, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 411.14, "standard_charge_percentage": 78.4000, "estimated_amount": 411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 121.44, "estimated_amount": 121, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 159.39, "estimated_amount": 159, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 321.82, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 524.41, "estimated_amount": 524, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 411.14, "standard_charge_percentage": 78.4000, "estimated_amount": 411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 419.53, "standard_charge_percentage": 80.0000, "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 242.88, "estimated_amount": 242, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 212.52, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 303.6, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 303.6, "estimated_amount": 303, "methodology": "fee schedule" }]}]} , { "description": "Hc Apply Forearm Splint", "code_information": [ { "code": "29126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 431, "discounted_cash": 197,"minimum": 80.38,"maximum": 431,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 215.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 215, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 366.35, "standard_charge_percentage": 85.0000, "estimated_amount": 366, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 337.9, "standard_charge_percentage": 78.4000, "estimated_amount": 337, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 303.6, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 159.39, "estimated_amount": 159, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 321.82, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 431, "estimated_amount": 431, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 366.35, "standard_charge_percentage": 85.0000, "estimated_amount": 366, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 344.8, "standard_charge_percentage": 80.0000, "estimated_amount": 344, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 129.3, "standard_charge_percentage": 30.0000, "estimated_amount": 129, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 344.8, "standard_charge_percentage": 80.0000, "estimated_amount": 344, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 303.6, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 80.38, "standard_charge_percentage": 18.6500, "estimated_amount": 80, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 81.99, "standard_charge_percentage": 19.0200, "estimated_amount": 81, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 84.39, "standard_charge_percentage": 19.5800, "estimated_amount": 84, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 337.9, "standard_charge_percentage": 78.4000, "estimated_amount": 337, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 242.88, "estimated_amount": 242, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 212.52, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 223.07, "estimated_amount": 223, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 431, "estimated_amount": 431, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 204.93, "estimated_amount": 204, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 121.44, "estimated_amount": 121, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 321.82, "estimated_amount": 321, "methodology": "fee schedule" }]}]} , { "description": "Hc Apply Finger Splint Static", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 524.41, "discounted_cash": 197,"minimum": 97.8,"maximum": 524.41,"payers_information":[{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 419.53, "standard_charge_percentage": 80.0000, "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 303.6, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 524.41, "estimated_amount": 524, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 445.75, "standard_charge_percentage": 85.0000, "estimated_amount": 445, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 99.76, "standard_charge_percentage": 19.0200, "estimated_amount": 99, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 411.14, "standard_charge_percentage": 78.4000, "estimated_amount": 411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 303.6, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 321.82, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 262.2, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 262, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 97.8, "standard_charge_percentage": 18.6500, "estimated_amount": 97, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 445.75, "standard_charge_percentage": 85.0000, "estimated_amount": 445, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 419.53, "standard_charge_percentage": 80.0000, "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 157.32, "standard_charge_percentage": 30.0000, "estimated_amount": 157, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 102.68, "standard_charge_percentage": 19.5800, "estimated_amount": 102, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 204.93, "estimated_amount": 204, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 121.44, "estimated_amount": 121, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 159.39, "estimated_amount": 159, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 321.82, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 524.41, "estimated_amount": 524, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 411.14, "standard_charge_percentage": 78.4000, "estimated_amount": 411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 242.88, "estimated_amount": 242, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 212.52, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 223.07, "estimated_amount": 223, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" }]}]} , { "description": "Hc Application Of Finger Splint", "code_information": [ { "code": "29131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 392, "discounted_cash": 90,"minimum": 55.96,"maximum": 392,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 333.2, "standard_charge_percentage": 85.0000, "estimated_amount": 333, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 74.57, "standard_charge_percentage": 19.0200, "estimated_amount": 74, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 117.6, "standard_charge_percentage": 30.0000, "estimated_amount": 117, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 120.38, "estimated_amount": 120, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 120.38, "estimated_amount": 120, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 97.93, "estimated_amount": 97, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 148.29, "estimated_amount": 148, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 392, "estimated_amount": 392, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 333.2, "standard_charge_percentage": 85.0000, "estimated_amount": 333, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 307.33, "standard_charge_percentage": 78.4000, "estimated_amount": 307, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 313.6, "standard_charge_percentage": 80.0000, "estimated_amount": 313, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 94.43, "estimated_amount": 94, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 55.96, "estimated_amount": 55, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 120.38, "estimated_amount": 120, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 102.79, "estimated_amount": 102, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 392, "estimated_amount": 392, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 196, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 196, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 313.6, "standard_charge_percentage": 80.0000, "estimated_amount": 313, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 307.33, "standard_charge_percentage": 78.4000, "estimated_amount": 307, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 139.9, "estimated_amount": 139, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 73.45, "estimated_amount": 73, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 73.11, "standard_charge_percentage": 18.6500, "estimated_amount": 73, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 76.75, "standard_charge_percentage": 19.5800, "estimated_amount": 76, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 111.92, "estimated_amount": 111, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 139.9, "estimated_amount": 139, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 148.29, "estimated_amount": 148, "methodology": "fee schedule" }]}]} , { "description": "Hc Strapping Shoulder", "code_information": [ { "code": "29240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 396.9, "discounted_cash": 197,"minimum": 74.02,"maximum": 396.9,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 396.9, "estimated_amount": 396, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 303.6, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 337.37, "standard_charge_percentage": 85.0000, "estimated_amount": 337, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 75.5, "standard_charge_percentage": 19.0200, "estimated_amount": 75, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 317.52, "standard_charge_percentage": 80.0000, "estimated_amount": 317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 311.17, "standard_charge_percentage": 78.4000, "estimated_amount": 311, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 204.93, "estimated_amount": 204, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 121.44, "estimated_amount": 121, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 242.88, "estimated_amount": 242, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 212.52, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 303.6, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 159.39, "estimated_amount": 159, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 321.82, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 396.9, "estimated_amount": 396, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 119.07, "standard_charge_percentage": 30.0000, "estimated_amount": 119, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 311.17, "standard_charge_percentage": 78.4000, "estimated_amount": 311, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 198.45, "standard_charge_percentage": 50.0000, "estimated_amount": 198, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 223.07, "estimated_amount": 223, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 74.02, "standard_charge_percentage": 18.6500, "estimated_amount": 74, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 337.37, "standard_charge_percentage": 85.0000, "estimated_amount": 337, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 77.71, "standard_charge_percentage": 19.5800, "estimated_amount": 77, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 317.52, "standard_charge_percentage": 80.0000, "estimated_amount": 317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 321.82, "estimated_amount": 321, "methodology": "fee schedule" }]}]} , { "description": "Hc Strapping Elbow Or Wrist", "code_information": [ { "code": "29260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 251.09, "discounted_cash": 90,"minimum": 46.83,"maximum": 251.09,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 213.43, "standard_charge_percentage": 85.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 47.76, "standard_charge_percentage": 19.0200, "estimated_amount": 47, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 200.87, "standard_charge_percentage": 80.0000, "estimated_amount": 200, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 75.33, "standard_charge_percentage": 30.0000, "estimated_amount": 75, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 49.16, "standard_charge_percentage": 19.5800, "estimated_amount": 49, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 196.85, "standard_charge_percentage": 78.4000, "estimated_amount": 196, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 125.55, "standard_charge_percentage": 50.0000, "estimated_amount": 125, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 55.96, "estimated_amount": 55, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 120.38, "estimated_amount": 120, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 102.79, "estimated_amount": 102, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 73.45, "estimated_amount": 73, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 196.85, "standard_charge_percentage": 78.4000, "estimated_amount": 196, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 120.38, "estimated_amount": 120, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 120.38, "estimated_amount": 120, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 139.9, "estimated_amount": 139, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 148.29, "estimated_amount": 148, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 251.09, "estimated_amount": 251, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 46.83, "standard_charge_percentage": 18.6500, "estimated_amount": 46, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 200.87, "standard_charge_percentage": 80.0000, "estimated_amount": 200, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 111.92, "estimated_amount": 111, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 97.93, "estimated_amount": 97, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 148.29, "estimated_amount": 148, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 251.09, "estimated_amount": 251, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 213.43, "standard_charge_percentage": 85.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 94.43, "estimated_amount": 94, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 139.9, "estimated_amount": 139, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" }]}]} , { "description": "Hc Strapping Hand Or Finger", "code_information": [ { "code": "29280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 294, "discounted_cash": 90,"minimum": 54.83,"maximum": 294,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 249.9, "standard_charge_percentage": 85.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 235.2, "standard_charge_percentage": 80.0000, "estimated_amount": 235, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 230.5, "standard_charge_percentage": 78.4000, "estimated_amount": 230, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 230.5, "standard_charge_percentage": 78.4000, "estimated_amount": 230, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 120.38, "estimated_amount": 120, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 148.29, "estimated_amount": 148, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 54.83, "standard_charge_percentage": 18.6500, "estimated_amount": 54, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 94.43, "estimated_amount": 94, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 55.96, "estimated_amount": 55, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 139.9, "estimated_amount": 139, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 148.29, "estimated_amount": 148, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 249.9, "standard_charge_percentage": 85.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 55.93, "standard_charge_percentage": 19.0200, "estimated_amount": 55, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 147, "standard_charge_percentage": 50.0000, "estimated_amount": 147, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 120.38, "estimated_amount": 120, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 102.79, "estimated_amount": 102, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 73.45, "estimated_amount": 73, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 294, "estimated_amount": 294, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 294, "estimated_amount": 294, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 88.2, "standard_charge_percentage": 30.0000, "estimated_amount": 88, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 57.57, "standard_charge_percentage": 19.5800, "estimated_amount": 57, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 235.2, "standard_charge_percentage": 80.0000, "estimated_amount": 235, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 120.38, "estimated_amount": 120, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 111.92, "estimated_amount": 111, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 97.93, "estimated_amount": 97, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 139.9, "estimated_amount": 139, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" }]}]} , { "description": "Hc Apply Short Leg Cast", "code_information": [ { "code": "29405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 878.11, "discounted_cash": 406,"minimum": 163.77,"maximum": 878.11,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 878.11, "estimated_amount": 878, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 746.39, "standard_charge_percentage": 85.0000, "estimated_amount": 746, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 688.44, "standard_charge_percentage": 78.4000, "estimated_amount": 688, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 702.49, "standard_charge_percentage": 80.0000, "estimated_amount": 702, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 538.26, "estimated_amount": 538, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 328.4, "estimated_amount": 328, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 663.05, "estimated_amount": 663, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 439.06, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 746.39, "standard_charge_percentage": 85.0000, "estimated_amount": 746, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 263.43, "standard_charge_percentage": 30.0000, "estimated_amount": 263, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 688.44, "standard_charge_percentage": 78.4000, "estimated_amount": 688, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 250.21, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 437.86, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 625.52, "estimated_amount": 625, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 459.6, "estimated_amount": 459, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 878.11, "estimated_amount": 878, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 163.77, "standard_charge_percentage": 18.6500, "estimated_amount": 163, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 167.04, "standard_charge_percentage": 19.0200, "estimated_amount": 167, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 171.93, "standard_charge_percentage": 19.5800, "estimated_amount": 171, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 538.26, "estimated_amount": 538, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 500.42, "estimated_amount": 500, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 663.05, "estimated_amount": 663, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 702.49, "standard_charge_percentage": 80.0000, "estimated_amount": 702, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 422.23, "estimated_amount": 422, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 538.26, "estimated_amount": 538, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 625.52, "estimated_amount": 625, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" }]}]} , { "description": "Hc Apply Short Leg Cast,Walker", "code_information": [ { "code": "29425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 448.88, "discounted_cash": 406,"minimum": 83.72,"maximum": 448.88,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 224.44, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 224, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 381.55, "standard_charge_percentage": 85.0000, "estimated_amount": 381, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 448.88, "estimated_amount": 448, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 448.88, "estimated_amount": 448, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 448.88, "estimated_amount": 448, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 359.1, "standard_charge_percentage": 80.0000, "estimated_amount": 359, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 351.92, "standard_charge_percentage": 78.4000, "estimated_amount": 351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 351.92, "standard_charge_percentage": 78.4000, "estimated_amount": 351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 422.23, "estimated_amount": 422, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 448.88, "estimated_amount": 448, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 448.88, "estimated_amount": 448, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 381.55, "standard_charge_percentage": 85.0000, "estimated_amount": 381, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 359.1, "standard_charge_percentage": 80.0000, "estimated_amount": 359, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 448.88, "estimated_amount": 448, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 448.88, "estimated_amount": 448, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 83.72, "standard_charge_percentage": 18.6500, "estimated_amount": 83, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 85.39, "standard_charge_percentage": 19.0200, "estimated_amount": 85, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 134.66, "standard_charge_percentage": 30.0000, "estimated_amount": 134, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 87.89, "standard_charge_percentage": 19.5800, "estimated_amount": 87, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 250.21, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 448.88, "estimated_amount": 448, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 448.88, "estimated_amount": 448, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 437.86, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 448.88, "estimated_amount": 448, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 448.88, "estimated_amount": 448, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 328.4, "estimated_amount": 328, "methodology": "fee schedule" }]}]} , { "description": "Hc Apply Rigid Leg Cast", "code_information": [ { "code": "29445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1102.49, "discounted_cash": 406,"minimum": 205.61,"maximum": 1102.49,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1102.49, "estimated_amount": 1102, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 937.12, "standard_charge_percentage": 85.0000, "estimated_amount": 937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 864.35, "standard_charge_percentage": 78.4000, "estimated_amount": 864, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 250.21, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 538.26, "estimated_amount": 538, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 625.52, "estimated_amount": 625, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 625.52, "estimated_amount": 625, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 551.25, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 551, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 205.61, "standard_charge_percentage": 18.6500, "estimated_amount": 205, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 937.12, "standard_charge_percentage": 85.0000, "estimated_amount": 937, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 209.73, "standard_charge_percentage": 19.0200, "estimated_amount": 209, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 881.99, "standard_charge_percentage": 80.0000, "estimated_amount": 881, "methodology": "percent of total billed charges" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 500.42, "estimated_amount": 500, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 663.05, "estimated_amount": 663, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 663.05, "estimated_amount": 663, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1102.49, "estimated_amount": 1102, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 215.87, "standard_charge_percentage": 19.5800, "estimated_amount": 215, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 422.23, "estimated_amount": 422, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 538.26, "estimated_amount": 538, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 538.26, "estimated_amount": 538, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 459.6, "estimated_amount": 459, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 881.99, "standard_charge_percentage": 80.0000, "estimated_amount": 881, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 330.75, "standard_charge_percentage": 30.0000, "estimated_amount": 330, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 864.35, "standard_charge_percentage": 78.4000, "estimated_amount": 864, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 437.86, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 328.4, "estimated_amount": 328, "methodology": "fee schedule" }]}]} , { "description": "Hc Appl Clubfoot Cast Molding/Manj Long/Short Leg", "code_information": [ { "code": "29450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 178.86, "discounted_cash": 241,"minimum": 33.36,"maximum": 178.86,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 178.86, "estimated_amount": 178, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 178.86, "estimated_amount": 178, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 140.23, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 140, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 33.36, "standard_charge_percentage": 18.6500, "estimated_amount": 33, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 143.09, "standard_charge_percentage": 80.0000, "estimated_amount": 143, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 178.86, "estimated_amount": 178, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 178.86, "estimated_amount": 178, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 178.86, "estimated_amount": 178, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 178.86, "estimated_amount": 178, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 178.86, "estimated_amount": 178, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 178.86, "estimated_amount": 178, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 140.23, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 140, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 178.86, "estimated_amount": 178, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 148.66, "estimated_amount": 148, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 178.86, "estimated_amount": 178, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 178.86, "estimated_amount": 178, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 34.02, "standard_charge_percentage": 19.0200, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 178.86, "estimated_amount": 178, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 178.86, "estimated_amount": 178, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 178.86, "estimated_amount": 178, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 178.86, "estimated_amount": 178, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 178.86, "estimated_amount": 178, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 178.86, "estimated_amount": 178, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 178.86, "estimated_amount": 178, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 178.86, "estimated_amount": 178, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 178.86, "estimated_amount": 178, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 178.86, "estimated_amount": 178, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 89.43, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 89, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 143.09, "standard_charge_percentage": 80.0000, "estimated_amount": 143, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 53.66, "standard_charge_percentage": 30.0000, "estimated_amount": 53, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 35.02, "standard_charge_percentage": 19.5800, "estimated_amount": 35, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 178.86, "estimated_amount": 178, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 178.86, "estimated_amount": 178, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 178.86, "estimated_amount": 178, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 178.86, "estimated_amount": 178, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 178.86, "estimated_amount": 178, "methodology": "fee schedule" }]}]} , { "description": "Hc Apply Long Leg Splint", "code_information": [ { "code": "29505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 646.85, "discounted_cash": 241,"minimum": 120.64,"maximum": 646.85,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 646.85, "estimated_amount": 646, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 646.85, "estimated_amount": 646, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 549.82, "standard_charge_percentage": 85.0000, "estimated_amount": 549, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 123.05, "standard_charge_percentage": 19.0200, "estimated_amount": 123, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 194.06, "standard_charge_percentage": 30.0000, "estimated_amount": 194, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 507.13, "standard_charge_percentage": 78.4000, "estimated_amount": 507, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 517.48, "standard_charge_percentage": 80.0000, "estimated_amount": 517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 297.31, "estimated_amount": 297, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 260.15, "estimated_amount": 260, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 148.66, "estimated_amount": 148, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 319.8, "estimated_amount": 319, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 319.8, "estimated_amount": 319, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 319.8, "estimated_amount": 319, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 371.64, "estimated_amount": 371, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 273.06, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 195.11, "estimated_amount": 195, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 393.94, "estimated_amount": 393, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 120.64, "standard_charge_percentage": 18.6500, "estimated_amount": 120, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 549.82, "standard_charge_percentage": 85.0000, "estimated_amount": 549, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 507.13, "standard_charge_percentage": 78.4000, "estimated_amount": 507, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 393.94, "estimated_amount": 393, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 323.43, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 323, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 517.48, "standard_charge_percentage": 80.0000, "estimated_amount": 517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 126.65, "standard_charge_percentage": 19.5800, "estimated_amount": 126, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 250.86, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 371.64, "estimated_amount": 371, "methodology": "fee schedule" }]}]} , { "description": "Hc Apply Lower Leg Splint", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 646.85, "discounted_cash": 241,"minimum": 120.64,"maximum": 646.85,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 646.85, "estimated_amount": 646, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 517.48, "standard_charge_percentage": 80.0000, "estimated_amount": 517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 194.06, "standard_charge_percentage": 30.0000, "estimated_amount": 194, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 507.13, "standard_charge_percentage": 78.4000, "estimated_amount": 507, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 371.64, "estimated_amount": 371, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 371.64, "estimated_amount": 371, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 393.94, "estimated_amount": 393, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 549.82, "standard_charge_percentage": 85.0000, "estimated_amount": 549, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 319.8, "estimated_amount": 319, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 273.06, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 195.11, "estimated_amount": 195, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 393.94, "estimated_amount": 393, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 323.43, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 323, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 120.64, "standard_charge_percentage": 18.6500, "estimated_amount": 120, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 549.82, "standard_charge_percentage": 85.0000, "estimated_amount": 549, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 123.05, "standard_charge_percentage": 19.0200, "estimated_amount": 123, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 507.13, "standard_charge_percentage": 78.4000, "estimated_amount": 507, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 517.48, "standard_charge_percentage": 80.0000, "estimated_amount": 517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 297.31, "estimated_amount": 297, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 260.15, "estimated_amount": 260, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 646.85, "estimated_amount": 646, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 126.65, "standard_charge_percentage": 19.5800, "estimated_amount": 126, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 250.86, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 148.66, "estimated_amount": 148, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 319.8, "estimated_amount": 319, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 319.8, "estimated_amount": 319, "methodology": "fee schedule" }]}]} , { "description": "Hc Strapping Of Hip", "code_information": [ { "code": "29520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.36, "discounted_cash": 197,"minimum": 38.86,"maximum": 208.36,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 208.36, "estimated_amount": 208, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 208.36, "estimated_amount": 208, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 40.8, "standard_charge_percentage": 19.5800, "estimated_amount": 40, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 166.69, "standard_charge_percentage": 80.0000, "estimated_amount": 166, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 208.36, "estimated_amount": 208, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 208.36, "estimated_amount": 208, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 208.36, "estimated_amount": 208, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 38.86, "standard_charge_percentage": 18.6500, "estimated_amount": 38, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 177.11, "standard_charge_percentage": 85.0000, "estimated_amount": 177, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 166.69, "standard_charge_percentage": 80.0000, "estimated_amount": 166, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 163.35, "standard_charge_percentage": 78.4000, "estimated_amount": 163, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 104.18, "standard_charge_percentage": 50.0000, "estimated_amount": 104, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 204.93, "estimated_amount": 204, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 208.36, "estimated_amount": 208, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 208.36, "estimated_amount": 208, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 177.11, "standard_charge_percentage": 85.0000, "estimated_amount": 177, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 39.64, "standard_charge_percentage": 19.0200, "estimated_amount": 39, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 62.51, "standard_charge_percentage": 30.0000, "estimated_amount": 62, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 208.36, "estimated_amount": 208, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 208.36, "estimated_amount": 208, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 208.36, "estimated_amount": 208, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 163.35, "standard_charge_percentage": 78.4000, "estimated_amount": 163, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 121.44, "estimated_amount": 121, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 208.36, "estimated_amount": 208, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 159.39, "estimated_amount": 159, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 208.36, "estimated_amount": 208, "methodology": "fee schedule" }]}]} , { "description": "Hc Strapping Knee", "code_information": [ { "code": "29530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 545.15, "discounted_cash": 197,"minimum": 101.67,"maximum": 545.15,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 545.15, "estimated_amount": 545, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 427.4, "standard_charge_percentage": 78.4000, "estimated_amount": 427, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 436.12, "standard_charge_percentage": 80.0000, "estimated_amount": 436, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 272.57, "standard_charge_percentage": 50.0000, "estimated_amount": 272, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 303.6, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 223.07, "estimated_amount": 223, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 321.82, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 545.15, "estimated_amount": 545, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 463.38, "standard_charge_percentage": 85.0000, "estimated_amount": 463, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 163.54, "standard_charge_percentage": 30.0000, "estimated_amount": 163, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 204.93, "estimated_amount": 204, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 121.44, "estimated_amount": 121, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 242.88, "estimated_amount": 242, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 212.52, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 303.6, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 159.39, "estimated_amount": 159, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 321.82, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 463.38, "standard_charge_percentage": 85.0000, "estimated_amount": 463, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 103.7, "standard_charge_percentage": 19.0200, "estimated_amount": 103, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 427.4, "standard_charge_percentage": 78.4000, "estimated_amount": 427, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 101.67, "standard_charge_percentage": 18.6500, "estimated_amount": 101, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 436.12, "standard_charge_percentage": 80.0000, "estimated_amount": 436, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 106.74, "standard_charge_percentage": 19.5800, "estimated_amount": 106, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" }]}]} , { "description": "Hc Strapping Of Ankle And/Or Ft", "code_information": [ { "code": "29540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 668.7, "discounted_cash": 241,"minimum": 124.71,"maximum": 668.7,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 534.96, "standard_charge_percentage": 80.0000, "estimated_amount": 534, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 200.61, "standard_charge_percentage": 30.0000, "estimated_amount": 200, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 524.26, "standard_charge_percentage": 78.4000, "estimated_amount": 524, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 319.8, "estimated_amount": 319, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 393.94, "estimated_amount": 393, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 668.7, "estimated_amount": 668, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 127.21, "standard_charge_percentage": 19.0200, "estimated_amount": 127, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 534.96, "standard_charge_percentage": 80.0000, "estimated_amount": 534, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 297.31, "estimated_amount": 297, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 260.15, "estimated_amount": 260, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 124.71, "standard_charge_percentage": 18.6500, "estimated_amount": 124, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 568.4, "standard_charge_percentage": 85.0000, "estimated_amount": 568, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 334.35, "standard_charge_percentage": 50.0000, "estimated_amount": 334, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 148.66, "estimated_amount": 148, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 273.06, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 195.11, "estimated_amount": 195, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 393.94, "estimated_amount": 393, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 668.7, "estimated_amount": 668, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 568.4, "standard_charge_percentage": 85.0000, "estimated_amount": 568, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 130.93, "standard_charge_percentage": 19.5800, "estimated_amount": 130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 524.26, "standard_charge_percentage": 78.4000, "estimated_amount": 524, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 250.86, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 319.8, "estimated_amount": 319, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 319.8, "estimated_amount": 319, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 371.64, "estimated_amount": 371, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 371.64, "estimated_amount": 371, "methodology": "fee schedule" }]}]} , { "description": "Hc Strapping Of Toes", "code_information": [ { "code": "29550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 291.4, "discounted_cash": 90,"minimum": 54.35,"maximum": 291.4,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 291.4, "estimated_amount": 291, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 228.46, "standard_charge_percentage": 78.4000, "estimated_amount": 228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 233.12, "standard_charge_percentage": 80.0000, "estimated_amount": 233, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 120.38, "estimated_amount": 120, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 139.9, "estimated_amount": 139, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 148.29, "estimated_amount": 148, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 54.35, "standard_charge_percentage": 18.6500, "estimated_amount": 54, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 233.12, "standard_charge_percentage": 80.0000, "estimated_amount": 233, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 87.42, "standard_charge_percentage": 30.0000, "estimated_amount": 87, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 94.43, "estimated_amount": 94, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 55.96, "estimated_amount": 55, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 139.9, "estimated_amount": 139, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 148.29, "estimated_amount": 148, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 291.4, "estimated_amount": 291, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 55.43, "standard_charge_percentage": 19.0200, "estimated_amount": 55, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 145.7, "standard_charge_percentage": 50.0000, "estimated_amount": 145, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 120.38, "estimated_amount": 120, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 111.92, "estimated_amount": 111, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 97.93, "estimated_amount": 97, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 247.69, "standard_charge_percentage": 85.0000, "estimated_amount": 247, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 247.69, "standard_charge_percentage": 85.0000, "estimated_amount": 247, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 57.06, "standard_charge_percentage": 19.5800, "estimated_amount": 57, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 228.46, "standard_charge_percentage": 78.4000, "estimated_amount": 228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 120.38, "estimated_amount": 120, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 69.95, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 102.79, "estimated_amount": 102, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 73.45, "estimated_amount": 73, "methodology": "fee schedule" }]}]} , { "description": "Hc Strapping Unna Boot", "code_information": [ { "code": "29580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 714, "discounted_cash": 241,"minimum": 133.16,"maximum": 714,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 714, "estimated_amount": 714, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 606.9, "standard_charge_percentage": 85.0000, "estimated_amount": 606, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 250.86, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 260.15, "estimated_amount": 260, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 714, "estimated_amount": 714, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 214.2, "standard_charge_percentage": 30.0000, "estimated_amount": 214, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 319.8, "estimated_amount": 319, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 319.8, "estimated_amount": 319, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 371.64, "estimated_amount": 371, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 393.94, "estimated_amount": 393, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 133.16, "standard_charge_percentage": 18.6500, "estimated_amount": 133, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 606.9, "standard_charge_percentage": 85.0000, "estimated_amount": 606, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 571.2, "standard_charge_percentage": 80.0000, "estimated_amount": 571, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 139.8, "standard_charge_percentage": 19.5800, "estimated_amount": 139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 559.78, "standard_charge_percentage": 78.4000, "estimated_amount": 559, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 571.2, "standard_charge_percentage": 80.0000, "estimated_amount": 571, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 357, "standard_charge_percentage": 50.0000, "estimated_amount": 357, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 319.8, "estimated_amount": 319, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 297.31, "estimated_amount": 297, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 371.64, "estimated_amount": 371, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 393.94, "estimated_amount": 393, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 135.82, "standard_charge_percentage": 19.0200, "estimated_amount": 135, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 559.78, "standard_charge_percentage": 78.4000, "estimated_amount": 559, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 148.66, "estimated_amount": 148, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 273.06, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 195.11, "estimated_amount": 195, "methodology": "fee schedule" }]}]} , { "description": "Hc Apply Multlay Comprs Lwr Leg", "code_information": [ { "code": "29581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 646.85, "discounted_cash": 241,"minimum": 120.64,"maximum": 646.85,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 646.85, "estimated_amount": 646, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 517.48, "standard_charge_percentage": 80.0000, "estimated_amount": 517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 194.06, "standard_charge_percentage": 30.0000, "estimated_amount": 194, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 507.13, "standard_charge_percentage": 78.4000, "estimated_amount": 507, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 507.13, "standard_charge_percentage": 78.4000, "estimated_amount": 507, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 148.66, "estimated_amount": 148, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 319.8, "estimated_amount": 319, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 319.8, "estimated_amount": 319, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 319.8, "estimated_amount": 319, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 371.64, "estimated_amount": 371, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 273.06, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 195.11, "estimated_amount": 195, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 393.94, "estimated_amount": 393, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 549.82, "standard_charge_percentage": 85.0000, "estimated_amount": 549, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 297.31, "estimated_amount": 297, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 260.15, "estimated_amount": 260, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 646.85, "estimated_amount": 646, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 126.65, "standard_charge_percentage": 19.5800, "estimated_amount": 126, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 250.86, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 371.64, "estimated_amount": 371, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 323.43, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 323, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 120.64, "standard_charge_percentage": 18.6500, "estimated_amount": 120, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 549.82, "standard_charge_percentage": 85.0000, "estimated_amount": 549, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 123.05, "standard_charge_percentage": 19.0200, "estimated_amount": 123, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 517.48, "standard_charge_percentage": 80.0000, "estimated_amount": 517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 393.94, "estimated_amount": 393, "methodology": "fee schedule" }]}]} , { "description": "Hc Remv/Revisn Boot/Body Cast", "code_information": [ { "code": "29700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 287.83, "discounted_cash": 406,"minimum": 53.68,"maximum": 287.83,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 225.66, "standard_charge_percentage": 78.4000, "estimated_amount": 225, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 287.83, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 287.83, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 287.83, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 287.83, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 287.83, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 287.83, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 287.83, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 287.83, "estimated_amount": 287, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 244.66, "standard_charge_percentage": 85.0000, "estimated_amount": 244, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 54.75, "standard_charge_percentage": 19.0200, "estimated_amount": 54, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 287.83, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 287.83, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 287.83, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 287.83, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 287.83, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 287.83, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 287.83, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 287.83, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 287.83, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 287.83, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 53.68, "standard_charge_percentage": 18.6500, "estimated_amount": 53, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 230.26, "standard_charge_percentage": 80.0000, "estimated_amount": 230, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 230.26, "standard_charge_percentage": 80.0000, "estimated_amount": 230, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 287.83, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 287.83, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 287.83, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 287.83, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 287.83, "estimated_amount": 287, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 244.66, "standard_charge_percentage": 85.0000, "estimated_amount": 244, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 86.35, "standard_charge_percentage": 30.0000, "estimated_amount": 86, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 56.36, "standard_charge_percentage": 19.5800, "estimated_amount": 56, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 225.66, "standard_charge_percentage": 78.4000, "estimated_amount": 225, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 287.83, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 250.21, "estimated_amount": 250, "methodology": "fee schedule" }]}]} , { "description": "Hc Remove Full Arm/Leg Cast", "code_information": [ { "code": "29705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 878.11, "discounted_cash": 406,"minimum": 163.77,"maximum": 878.11,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 746.39, "standard_charge_percentage": 85.0000, "estimated_amount": 746, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 263.43, "standard_charge_percentage": 30.0000, "estimated_amount": 263, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 702.49, "standard_charge_percentage": 80.0000, "estimated_amount": 702, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 422.23, "estimated_amount": 422, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 500.42, "estimated_amount": 500, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 437.86, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 625.52, "estimated_amount": 625, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 459.6, "estimated_amount": 459, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 878.11, "estimated_amount": 878, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 167.04, "standard_charge_percentage": 19.0200, "estimated_amount": 167, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 688.44, "standard_charge_percentage": 78.4000, "estimated_amount": 688, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 538.26, "estimated_amount": 538, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 538.26, "estimated_amount": 538, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 163.77, "standard_charge_percentage": 18.6500, "estimated_amount": 163, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 746.39, "standard_charge_percentage": 85.0000, "estimated_amount": 746, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 702.49, "standard_charge_percentage": 80.0000, "estimated_amount": 702, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 688.44, "standard_charge_percentage": 78.4000, "estimated_amount": 688, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 663.05, "estimated_amount": 663, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 878.11, "estimated_amount": 878, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 171.93, "standard_charge_percentage": 19.5800, "estimated_amount": 171, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 312.76, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 250.21, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 538.26, "estimated_amount": 538, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 625.52, "estimated_amount": 625, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 328.4, "estimated_amount": 328, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 663.05, "estimated_amount": 663, "methodology": "fee schedule" }]}]} , { "description": "Hc Windowing Of Cast", "code_information": [ { "code": "29730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 501.79, "discounted_cash": 241,"minimum": 93.58,"maximum": 501.79,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 401.43, "standard_charge_percentage": 80.0000, "estimated_amount": 401, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 98.25, "standard_charge_percentage": 19.5800, "estimated_amount": 98, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 393.4, "standard_charge_percentage": 78.4000, "estimated_amount": 393, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 401.43, "standard_charge_percentage": 80.0000, "estimated_amount": 401, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 250.86, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 297.31, "estimated_amount": 297, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 150.54, "standard_charge_percentage": 30.0000, "estimated_amount": 150, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 319.8, "estimated_amount": 319, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 371.64, "estimated_amount": 371, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 371.64, "estimated_amount": 371, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 393.94, "estimated_amount": 393, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 93.58, "standard_charge_percentage": 18.6500, "estimated_amount": 93, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 426.52, "standard_charge_percentage": 85.0000, "estimated_amount": 426, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 393.4, "standard_charge_percentage": 78.4000, "estimated_amount": 393, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 319.8, "estimated_amount": 319, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 260.15, "estimated_amount": 260, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 501.79, "estimated_amount": 501, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 501.79, "estimated_amount": 501, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 426.52, "standard_charge_percentage": 85.0000, "estimated_amount": 426, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 95.46, "standard_charge_percentage": 19.0200, "estimated_amount": 95, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 148.66, "estimated_amount": 148, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 319.8, "estimated_amount": 319, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 273.06, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 195.11, "estimated_amount": 195, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 393.94, "estimated_amount": 393, "methodology": "fee schedule" }]}]} , { "description": "Hc Cast/Strap Procedure Unlisted", "code_information": [ { "code": "29799", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 268, "discounted_cash": 241,"minimum": 49.98,"maximum": 268,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 49.98, "standard_charge_percentage": 18.6500, "estimated_amount": 49, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 210.11, "standard_charge_percentage": 78.4000, "estimated_amount": 210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 214.4, "standard_charge_percentage": 80.0000, "estimated_amount": 214, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 268, "estimated_amount": 268, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 268, "estimated_amount": 268, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 250.86, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 268, "estimated_amount": 268, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 268, "estimated_amount": 268, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 268, "estimated_amount": 268, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 268, "estimated_amount": 268, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 268, "estimated_amount": 268, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 52.47, "standard_charge_percentage": 19.5800, "estimated_amount": 52, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 210.11, "standard_charge_percentage": 78.4000, "estimated_amount": 210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 134, "standard_charge_percentage": 50.0000, "estimated_amount": 134, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 148.66, "estimated_amount": 148, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 268, "estimated_amount": 268, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 268, "estimated_amount": 268, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 195.11, "estimated_amount": 195, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 227.8, "standard_charge_percentage": 85.0000, "estimated_amount": 227, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 227.8, "standard_charge_percentage": 85.0000, "estimated_amount": 227, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 50.98, "standard_charge_percentage": 19.0200, "estimated_amount": 50, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 214.4, "standard_charge_percentage": 80.0000, "estimated_amount": 214, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 80.4, "standard_charge_percentage": 30.0000, "estimated_amount": 80, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 260.15, "estimated_amount": 260, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 268, "estimated_amount": 268, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 268, "estimated_amount": 268, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 185.82, "estimated_amount": 185, "methodology": "fee schedule" }]}]} , { "description": "Sho arthrs srg capsulorraphy", "code_information": [ { "code": "29806", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44089.5, "discounted_cash": 10936,"minimum": 1715,"maximum": 35271.6,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 8222.69, "standard_charge_percentage": 18.6500, "estimated_amount": 8222, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 35271.6, "standard_charge_percentage": 80.0000, "estimated_amount": 35271, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 8387.15, "standard_charge_percentage": 19.0200, "estimated_amount": 8387, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 35271.6, "standard_charge_percentage": 80.0000, "estimated_amount": 35271, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 8632.72, "standard_charge_percentage": 19.5800, "estimated_amount": 8632, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 13226.9, "standard_charge_percentage": 30.0000, "estimated_amount": 13226, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29807", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22690.5, "discounted_cash": 10936,"minimum": 1715,"maximum": 18152.4,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4231.78, "standard_charge_percentage": 18.6500, "estimated_amount": 4231, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4316.41, "standard_charge_percentage": 19.0200, "estimated_amount": 4316, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 18152.4, "standard_charge_percentage": 80.0000, "estimated_amount": 18152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 18152.4, "standard_charge_percentage": 80.0000, "estimated_amount": 18152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6807.15, "standard_charge_percentage": 30.0000, "estimated_amount": 6807, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4442.8, "standard_charge_percentage": 19.5800, "estimated_amount": 4442, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29821", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17041.5, "discounted_cash": 4967,"minimum": 1715,"maximum": 13633.2,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3178.24, "standard_charge_percentage": 18.6500, "estimated_amount": 3178, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3241.8, "standard_charge_percentage": 19.0200, "estimated_amount": 3241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5112.45, "standard_charge_percentage": 30.0000, "estimated_amount": 5112, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3336.73, "standard_charge_percentage": 19.5800, "estimated_amount": 3336, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8520.75, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8520, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13633.2, "standard_charge_percentage": 80.0000, "estimated_amount": 13633, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13633.2, "standard_charge_percentage": 80.0000, "estimated_amount": 13633, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29822", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24355.3, "discounted_cash": 4967,"minimum": 1715,"maximum": 19484.2,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7306.57, "standard_charge_percentage": 30.0000, "estimated_amount": 7306, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 19484.2, "standard_charge_percentage": 80.0000, "estimated_amount": 19484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4542.25, "standard_charge_percentage": 18.6500, "estimated_amount": 4542, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4633.1, "standard_charge_percentage": 19.0200, "estimated_amount": 4633, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 19484.2, "standard_charge_percentage": 80.0000, "estimated_amount": 19484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4768.76, "standard_charge_percentage": 19.5800, "estimated_amount": 4768, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Sho Arthrs Srg Xtnsv Dbrdmt", "code_information": [ { "code": "29823", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28015.3, "discounted_cash": 4967,"minimum": 1715,"maximum": 22412.2,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5224.85, "standard_charge_percentage": 18.6500, "estimated_amount": 5224, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5329.35, "standard_charge_percentage": 19.0200, "estimated_amount": 5329, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8404.59, "standard_charge_percentage": 30.0000, "estimated_amount": 8404, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5485.4, "standard_charge_percentage": 19.5800, "estimated_amount": 5485, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 22412.2, "standard_charge_percentage": 80.0000, "estimated_amount": 22412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 22412.2, "standard_charge_percentage": 80.0000, "estimated_amount": 22412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29824", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8244.21, "discounted_cash": 4967,"minimum": 1537.55,"maximum": 8100.6,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4122.1, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4122, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1537.55, "standard_charge_percentage": 18.6500, "estimated_amount": 1537, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1568.3, "standard_charge_percentage": 19.0200, "estimated_amount": 1568, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2473.26, "standard_charge_percentage": 30.0000, "estimated_amount": 2473, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6595.37, "standard_charge_percentage": 80.0000, "estimated_amount": 6595, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1614.22, "standard_charge_percentage": 19.5800, "estimated_amount": 1614, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6595.37, "standard_charge_percentage": 80.0000, "estimated_amount": 6595, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5666.22, "discounted_cash": 4967,"minimum": 1056.75,"maximum": 5666.22,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5666.22, "estimated_amount": 5666, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4532.98, "standard_charge_percentage": 80.0000, "estimated_amount": 4532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1109.45, "standard_charge_percentage": 19.5800, "estimated_amount": 1109, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 5666.22, "estimated_amount": 5666, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4442.32, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4442, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4442.32, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4442, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5666.22, "estimated_amount": 5666, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5666.22, "estimated_amount": 5666, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2833.11, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2833, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1056.75, "standard_charge_percentage": 18.6500, "estimated_amount": 1056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1699.87, "standard_charge_percentage": 30.0000, "estimated_amount": 1699, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4532.98, "standard_charge_percentage": 80.0000, "estimated_amount": 4532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5666.22, "estimated_amount": 5666, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5666.22, "estimated_amount": 5666, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5666.22, "estimated_amount": 5666, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1077.89, "standard_charge_percentage": 19.0200, "estimated_amount": 1077, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5666.22, "estimated_amount": 5666, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 5666.22, "estimated_amount": 5666, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 5666.22, "estimated_amount": 5666, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29826", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9563.75,"minimum": 1715,"maximum": 7651,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7651, "standard_charge_percentage": 80.0000, "estimated_amount": 7651, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4781.88, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4781, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2869.13, "standard_charge_percentage": 30.0000, "estimated_amount": 2869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1783.64, "standard_charge_percentage": 18.6500, "estimated_amount": 1783, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1872.58, "standard_charge_percentage": 19.5800, "estimated_amount": 1872, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7651, "standard_charge_percentage": 80.0000, "estimated_amount": 7651, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1819.31, "standard_charge_percentage": 19.0200, "estimated_amount": 1819, "methodology": "percent of total billed charges" }]}]} , { "description": "Sho arthrs srg rt8tr cuf rpr", "code_information": [ { "code": "29827", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53559, "discounted_cash": 10936,"minimum": 1715,"maximum": 42847.2,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 42847.2, "standard_charge_percentage": 80.0000, "estimated_amount": 42847, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 10188.5, "standard_charge_percentage": 19.0200, "estimated_amount": 10188, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 42847.2, "standard_charge_percentage": 80.0000, "estimated_amount": 42847, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 9988.75, "standard_charge_percentage": 18.6500, "estimated_amount": 9988, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 16067.7, "standard_charge_percentage": 30.0000, "estimated_amount": 16067, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 10486.9, "standard_charge_percentage": 19.5800, "estimated_amount": 10486, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29828", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8734.13, "discounted_cash": 10936,"minimum": 1628.92,"maximum": 8734.13,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6987.3, "standard_charge_percentage": 80.0000, "estimated_amount": 6987, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2620.24, "standard_charge_percentage": 30.0000, "estimated_amount": 2620, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6987.3, "standard_charge_percentage": 80.0000, "estimated_amount": 6987, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 8734.13, "estimated_amount": 8734, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8734.13, "estimated_amount": 8734, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8734.13, "estimated_amount": 8734, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4367.06, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4367, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 8734.13, "estimated_amount": 8734, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8734.13, "estimated_amount": 8734, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1661.49, "standard_charge_percentage": 19.0200, "estimated_amount": 1661, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 8734.13, "estimated_amount": 8734, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 8734.13, "estimated_amount": 8734, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 8734.13, "estimated_amount": 8734, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1628.92, "standard_charge_percentage": 18.6500, "estimated_amount": 1628, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1710.14, "standard_charge_percentage": 19.5800, "estimated_amount": 1710, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 8734.13, "estimated_amount": 8734, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 8734.13, "estimated_amount": 8734, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 8734.13, "estimated_amount": 8734, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8734.13, "estimated_amount": 8734, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29838", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17853.3, "discounted_cash": 4967,"minimum": 1715,"maximum": 14282.7,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8926.67, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8926, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3396.24, "standard_charge_percentage": 19.0200, "estimated_amount": 3396, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3495.68, "standard_charge_percentage": 19.5800, "estimated_amount": 3495, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3329.65, "standard_charge_percentage": 18.6500, "estimated_amount": 3329, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14282.7, "standard_charge_percentage": 80.0000, "estimated_amount": 14282, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5356, "standard_charge_percentage": 30.0000, "estimated_amount": 5356, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14282.7, "standard_charge_percentage": 80.0000, "estimated_amount": 14282, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29845", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14425, "discounted_cash": 4967,"minimum": 1715,"maximum": 11540,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2690.26, "standard_charge_percentage": 18.6500, "estimated_amount": 2690, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4327.5, "standard_charge_percentage": 30.0000, "estimated_amount": 4327, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2824.41, "standard_charge_percentage": 19.5800, "estimated_amount": 2824, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2744.07, "standard_charge_percentage": 19.0200, "estimated_amount": 2744, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7212.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7212, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 11540, "standard_charge_percentage": 80.0000, "estimated_amount": 11540, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 11540, "standard_charge_percentage": 80.0000, "estimated_amount": 11540, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Wrist Arthroscopy/Surgery", "code_information": [ { "code": "29846", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26683, "discounted_cash": 4967,"minimum": 1715,"maximum": 21346.4,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4976.38, "standard_charge_percentage": 18.6500, "estimated_amount": 4976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 21346.4, "standard_charge_percentage": 80.0000, "estimated_amount": 21346, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8004.9, "standard_charge_percentage": 30.0000, "estimated_amount": 8004, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5224.53, "standard_charge_percentage": 19.5800, "estimated_amount": 5224, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5075.91, "standard_charge_percentage": 19.0200, "estimated_amount": 5075, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 21346.4, "standard_charge_percentage": 80.0000, "estimated_amount": 21346, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" }]}]} , { "description": "Wrist Endoscopy/Surgery", "code_information": [ { "code": "29848", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16937.5, "discounted_cash": 2450,"minimum": 1507.78,"maximum": 13550,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3158.84, "standard_charge_percentage": 18.6500, "estimated_amount": 3158, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5081.25, "standard_charge_percentage": 30.0000, "estimated_amount": 5081, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3316.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3316, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2544.39, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8468.75, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1507.78, "estimated_amount": 1507, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2769.61, "estimated_amount": 2769, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3995.63, "estimated_amount": 3995, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3222.02, "standard_charge_percentage": 19.0200, "estimated_amount": 3222, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13550, "standard_charge_percentage": 80.0000, "estimated_amount": 13550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3015.57, "estimated_amount": 3015, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1978.97, "estimated_amount": 1978, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13550, "standard_charge_percentage": 80.0000, "estimated_amount": 13550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3243.62, "estimated_amount": 3243, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2638.62, "estimated_amount": 2638, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3769.46, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1884.73, "estimated_amount": 1884, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29862", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32456.3, "discounted_cash": 10936,"minimum": 1715,"maximum": 25965,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 6053.09, "standard_charge_percentage": 18.6500, "estimated_amount": 6053, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 25965, "standard_charge_percentage": 80.0000, "estimated_amount": 25965, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 6354.93, "standard_charge_percentage": 19.5800, "estimated_amount": 6354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 6174.15, "standard_charge_percentage": 19.0200, "estimated_amount": 6174, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 9736.88, "standard_charge_percentage": 30.0000, "estimated_amount": 9736, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 25965, "standard_charge_percentage": 80.0000, "estimated_amount": 25965, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29863", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10818.8, "discounted_cash": 4967,"minimum": 1715,"maximum": 8655,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5409.38, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5409, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3245.63, "standard_charge_percentage": 30.0000, "estimated_amount": 3245, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2118.31, "standard_charge_percentage": 19.5800, "estimated_amount": 2118, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8655, "standard_charge_percentage": 80.0000, "estimated_amount": 8655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2017.7, "standard_charge_percentage": 18.6500, "estimated_amount": 2017, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2058.05, "standard_charge_percentage": 19.0200, "estimated_amount": 2058, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8655, "standard_charge_percentage": 80.0000, "estimated_amount": 8655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29873", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14058.3, "discounted_cash": 4967,"minimum": 1715,"maximum": 11246.7,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2674.32, "standard_charge_percentage": 19.0200, "estimated_amount": 2674, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 11246.7, "standard_charge_percentage": 80.0000, "estimated_amount": 11246, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2752.62, "standard_charge_percentage": 19.5800, "estimated_amount": 2752, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7029.17, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7029, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4217.5, "standard_charge_percentage": 30.0000, "estimated_amount": 4217, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2621.88, "standard_charge_percentage": 18.6500, "estimated_amount": 2621, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 11246.7, "standard_charge_percentage": 80.0000, "estimated_amount": 11246, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29875", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15418.5, "discounted_cash": 4967,"minimum": 1715,"maximum": 12334.8,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2875.55, "standard_charge_percentage": 18.6500, "estimated_amount": 2875, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2933.06, "standard_charge_percentage": 19.0200, "estimated_amount": 2933, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12334.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12334, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7709.25, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7709, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12334.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12334, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4625.55, "standard_charge_percentage": 30.0000, "estimated_amount": 4625, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3018.94, "standard_charge_percentage": 19.5800, "estimated_amount": 3018, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Knee arthroscopy/surgery", "code_information": [ { "code": "29876", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21910.5, "discounted_cash": 4967,"minimum": 1715,"maximum": 17528.4,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4086.31, "standard_charge_percentage": 18.6500, "estimated_amount": 4086, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 17528.4, "standard_charge_percentage": 80.0000, "estimated_amount": 17528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 17528.4, "standard_charge_percentage": 80.0000, "estimated_amount": 17528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4290.08, "standard_charge_percentage": 19.5800, "estimated_amount": 4290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6573.15, "standard_charge_percentage": 30.0000, "estimated_amount": 6573, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4168.03, "standard_charge_percentage": 19.0200, "estimated_amount": 4168, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29879", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9441.36, "discounted_cash": 4967,"minimum": 1715,"maximum": 8100.6,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4720.68, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4720, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2832.41, "standard_charge_percentage": 30.0000, "estimated_amount": 2832, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1848.62, "standard_charge_percentage": 19.5800, "estimated_amount": 1848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1796.03, "standard_charge_percentage": 19.0200, "estimated_amount": 1796, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7553.09, "standard_charge_percentage": 80.0000, "estimated_amount": 7553, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7553.09, "standard_charge_percentage": 80.0000, "estimated_amount": 7553, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1760.81, "standard_charge_percentage": 18.6500, "estimated_amount": 1760, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" }]}]} , { "description": "Knee arthroscopysurgery", "code_information": [ { "code": "29880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30187.8, "discounted_cash": 4967,"minimum": 1715,"maximum": 24150.2,"payers_information":[{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5630.02, "standard_charge_percentage": 18.6500, "estimated_amount": 5630, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5742.63, "standard_charge_percentage": 19.0200, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 9056.34, "standard_charge_percentage": 30.0000, "estimated_amount": 9056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 24150.2, "standard_charge_percentage": 80.0000, "estimated_amount": 24150, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5910.77, "standard_charge_percentage": 19.5800, "estimated_amount": 5910, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 24150.2, "standard_charge_percentage": 80.0000, "estimated_amount": 24150, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" }]}]} , { "description": "Knee arthroscopy/surgery", "code_information": [ { "code": "29881", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28240.2, "discounted_cash": 4967,"minimum": 1715,"maximum": 22592.2,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 5266.8, "standard_charge_percentage": 18.6500, "estimated_amount": 5266, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 5372.13, "standard_charge_percentage": 19.0200, "estimated_amount": 5372, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 22592.2, "standard_charge_percentage": 80.0000, "estimated_amount": 22592, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 5529.43, "standard_charge_percentage": 19.5800, "estimated_amount": 5529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 22592.2, "standard_charge_percentage": 80.0000, "estimated_amount": 22592, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8472.06, "standard_charge_percentage": 30.0000, "estimated_amount": 8472, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29882", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9927.99, "discounted_cash": 4967,"minimum": 1715,"maximum": 8100.6,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 4963.99, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 4963, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2978.4, "standard_charge_percentage": 30.0000, "estimated_amount": 2978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7942.39, "standard_charge_percentage": 80.0000, "estimated_amount": 7942, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7942.39, "standard_charge_percentage": 80.0000, "estimated_amount": 7942, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1851.57, "standard_charge_percentage": 18.6500, "estimated_amount": 1851, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1888.6, "standard_charge_percentage": 19.0200, "estimated_amount": 1888, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1943.9, "standard_charge_percentage": 19.5800, "estimated_amount": 1943, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29883", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12984, "discounted_cash": 4967,"minimum": 1715,"maximum": 10387.2,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2421.52, "standard_charge_percentage": 18.6500, "estimated_amount": 2421, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2469.95, "standard_charge_percentage": 19.0200, "estimated_amount": 2469, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2542.27, "standard_charge_percentage": 19.5800, "estimated_amount": 2542, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 6492, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 6492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3895.2, "standard_charge_percentage": 30.0000, "estimated_amount": 3895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10387.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10387, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10387.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10387, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29888", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12344, "discounted_cash": 10936,"minimum": 1715,"maximum": 12344,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 6172.02, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 6172, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2302.16, "standard_charge_percentage": 18.6500, "estimated_amount": 2302, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2348.21, "standard_charge_percentage": 19.0200, "estimated_amount": 2348, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 12344, "estimated_amount": 12344, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 12344, "estimated_amount": 12344, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 12344, "estimated_amount": 12344, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 12344, "estimated_amount": 12344, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3703.21, "standard_charge_percentage": 30.0000, "estimated_amount": 3703, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 12344, "estimated_amount": 12344, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 12344, "estimated_amount": 12344, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 12344, "estimated_amount": 12344, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9875.23, "standard_charge_percentage": 80.0000, "estimated_amount": 9875, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2416.96, "standard_charge_percentage": 19.5800, "estimated_amount": 2416, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9875.23, "standard_charge_percentage": 80.0000, "estimated_amount": 9875, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 12344, "estimated_amount": 12344, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12344, "estimated_amount": 12344, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29889", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10740, "discounted_cash": 19698,"minimum": 1715,"maximum": 10740,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2043.07, "standard_charge_percentage": 19.0200, "estimated_amount": 2043, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2102.89, "standard_charge_percentage": 19.5800, "estimated_amount": 2102, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 10740, "estimated_amount": 10740, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 10740, "estimated_amount": 10740, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 10740, "estimated_amount": 10740, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 10740, "estimated_amount": 10740, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 10740, "estimated_amount": 10740, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 10740, "estimated_amount": 10740, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2003.01, "standard_charge_percentage": 18.6500, "estimated_amount": 2003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 10740, "estimated_amount": 10740, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 10740, "estimated_amount": 10740, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 10740, "estimated_amount": 10740, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 10740, "estimated_amount": 10740, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 10740, "estimated_amount": 10740, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8592, "standard_charge_percentage": 80.0000, "estimated_amount": 8592, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 10740, "estimated_amount": 10740, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 10740, "estimated_amount": 10740, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 10740, "estimated_amount": 10740, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 10740, "estimated_amount": 10740, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 10740, "estimated_amount": 10740, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 10740, "estimated_amount": 10740, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10740, "estimated_amount": 10740, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5370, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5370, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8592, "standard_charge_percentage": 80.0000, "estimated_amount": 8592, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3222, "standard_charge_percentage": 30.0000, "estimated_amount": 3222, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 10740, "estimated_amount": 10740, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 10740, "estimated_amount": 10740, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 10740, "estimated_amount": 10740, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10740, "estimated_amount": 10740, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 10740, "estimated_amount": 10740, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29891", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15112.1, "discounted_cash": 4967,"minimum": 1715,"maximum": 12089.7,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2874.78, "standard_charge_percentage": 19.0200, "estimated_amount": 2874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4533.64, "standard_charge_percentage": 30.0000, "estimated_amount": 4533, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2958.96, "standard_charge_percentage": 19.5800, "estimated_amount": 2958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7556.07, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2818.41, "standard_charge_percentage": 18.6500, "estimated_amount": 2818, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12089.7, "standard_charge_percentage": 80.0000, "estimated_amount": 12089, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12089.7, "standard_charge_percentage": 80.0000, "estimated_amount": 12089, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29892", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25425.8, "discounted_cash": 10936,"minimum": 1715,"maximum": 20340.6,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 4836.74, "standard_charge_percentage": 19.0200, "estimated_amount": 4836, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4978.36, "standard_charge_percentage": 19.5800, "estimated_amount": 4978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 20340.6, "standard_charge_percentage": 80.0000, "estimated_amount": 20340, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5667, "estimated_amount": 5667, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 20340.6, "standard_charge_percentage": 80.0000, "estimated_amount": 20340, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 4741.9, "standard_charge_percentage": 18.6500, "estimated_amount": 4741, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7627.73, "standard_charge_percentage": 30.0000, "estimated_amount": 7627, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" }]}]} , { "description": "Scope plantar fasciotomy", "code_information": [ { "code": "29893", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20195, "discounted_cash": 4967,"minimum": 1715,"maximum": 16156,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3841.69, "standard_charge_percentage": 19.0200, "estimated_amount": 3841, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 16156, "standard_charge_percentage": 80.0000, "estimated_amount": 16156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3954.18, "standard_charge_percentage": 19.5800, "estimated_amount": 3954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3766.37, "standard_charge_percentage": 18.6500, "estimated_amount": 3766, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 16156, "standard_charge_percentage": 80.0000, "estimated_amount": 16156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6058.5, "standard_charge_percentage": 30.0000, "estimated_amount": 6058, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29895", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10116.4, "discounted_cash": 4967,"minimum": 1715,"maximum": 8100.6,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1924.44, "standard_charge_percentage": 19.0200, "estimated_amount": 1924, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5058.19, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5058, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1886.7, "standard_charge_percentage": 18.6500, "estimated_amount": 1886, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8093.1, "standard_charge_percentage": 80.0000, "estimated_amount": 8093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8093.1, "standard_charge_percentage": 80.0000, "estimated_amount": 8093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3034.91, "standard_charge_percentage": 30.0000, "estimated_amount": 3034, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1980.79, "standard_charge_percentage": 19.5800, "estimated_amount": 1980, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29897", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11023.9, "discounted_cash": 4967,"minimum": 1715,"maximum": 8819.08,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2097.07, "standard_charge_percentage": 19.0200, "estimated_amount": 2097, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2158.47, "standard_charge_percentage": 19.5800, "estimated_amount": 2158, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5511.93, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5511, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2055.95, "standard_charge_percentage": 18.6500, "estimated_amount": 2055, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8819.08, "standard_charge_percentage": 80.0000, "estimated_amount": 8819, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3307.16, "standard_charge_percentage": 30.0000, "estimated_amount": 3307, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8819.08, "standard_charge_percentage": 80.0000, "estimated_amount": 8819, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Hc Arthroscopy Ankle Surgical Debridement Extensive", "code_information": [ { "code": "29898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14883.3, "discounted_cash": 4967,"minimum": 1715,"maximum": 28922.4,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 11906.6, "standard_charge_percentage": 80.0000, "estimated_amount": 11906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4464.99, "standard_charge_percentage": 30.0000, "estimated_amount": 4464, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7441.65, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7441, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2831.25, "standard_charge_percentage": 19.0200, "estimated_amount": 2831, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2914.15, "standard_charge_percentage": 19.5800, "estimated_amount": 2914, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2775.74, "standard_charge_percentage": 18.6500, "estimated_amount": 2775, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 11906.6, "standard_charge_percentage": 80.0000, "estimated_amount": 11906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 6877.39, "standard_charge_percentage": 19.0200, "estimated_amount": 6877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 28922.4, "standard_charge_percentage": 80.0000, "estimated_amount": 28922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 10845.9, "standard_charge_percentage": 30.0000, "estimated_amount": 10845, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 28922.4, "standard_charge_percentage": 80.0000, "estimated_amount": 28922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 6742.53, "standard_charge_percentage": 18.6500, "estimated_amount": 6742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 7078.76, "standard_charge_percentage": 19.5800, "estimated_amount": 7078, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10796.7, "discounted_cash": 10936,"minimum": 1715,"maximum": 10796.7,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5398.37, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5398, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2053.86, "standard_charge_percentage": 19.0200, "estimated_amount": 2053, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 10796.7, "estimated_amount": 10796, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 10796.7, "estimated_amount": 10796, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 10796.7, "estimated_amount": 10796, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10796.7, "estimated_amount": 10796, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 10796.7, "estimated_amount": 10796, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10796.7, "estimated_amount": 10796, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 10796.7, "estimated_amount": 10796, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 10796.7, "estimated_amount": 10796, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2013.59, "standard_charge_percentage": 18.6500, "estimated_amount": 2013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8637.39, "standard_charge_percentage": 80.0000, "estimated_amount": 8637, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3239.02, "standard_charge_percentage": 30.0000, "estimated_amount": 3239, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2114, "standard_charge_percentage": 19.5800, "estimated_amount": 2114, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8637.39, "standard_charge_percentage": 80.0000, "estimated_amount": 8637, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 10796.7, "estimated_amount": 10796, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 10796.7, "estimated_amount": 10796, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 10796.7, "estimated_amount": 10796, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10712, "discounted_cash": 10936,"minimum": 1715,"maximum": 10712,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2037.74, "standard_charge_percentage": 19.0200, "estimated_amount": 2037, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 10712, "estimated_amount": 10712, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 10712, "estimated_amount": 10712, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 10712, "estimated_amount": 10712, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10712, "estimated_amount": 10712, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 10712, "estimated_amount": 10712, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 10712, "estimated_amount": 10712, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10712, "estimated_amount": 10712, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2097.41, "standard_charge_percentage": 19.5800, "estimated_amount": 2097, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 10712, "estimated_amount": 10712, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5356, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5356, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1997.79, "standard_charge_percentage": 18.6500, "estimated_amount": 1997, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8569.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8569, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3213.6, "standard_charge_percentage": 30.0000, "estimated_amount": 3213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8569.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8569, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 10712, "estimated_amount": 10712, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 10712, "estimated_amount": 10712, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 10712, "estimated_amount": 10712, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29906", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17256.6, "discounted_cash": 4967,"minimum": 1715,"maximum": 13805.3,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3282.73, "standard_charge_percentage": 19.0200, "estimated_amount": 3282, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13805.3, "standard_charge_percentage": 80.0000, "estimated_amount": 13805, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5158.4, "estimated_amount": 5158, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3056.83, "estimated_amount": 3056, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4012.09, "estimated_amount": 4012, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5176.99, "standard_charge_percentage": 30.0000, "estimated_amount": 5176, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13805.3, "standard_charge_percentage": 80.0000, "estimated_amount": 13805, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6113.66, "estimated_amount": 6113, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7642.08, "estimated_amount": 7642, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8628.32, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8628, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3218.36, "standard_charge_percentage": 18.6500, "estimated_amount": 3218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3378.85, "standard_charge_percentage": 19.5800, "estimated_amount": 3378, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5349.46, "estimated_amount": 5349, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5615.02, "estimated_amount": 5615, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6576.01, "estimated_amount": 6576, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3821.04, "estimated_amount": 3821, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8100.6, "estimated_amount": 8100, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29907", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10945, "discounted_cash": 19698,"minimum": 1715,"maximum": 10945,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2041.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2041, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2082.06, "standard_charge_percentage": 19.0200, "estimated_amount": 2082, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 10945, "estimated_amount": 10944, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 10945, "estimated_amount": 10944, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 10945, "estimated_amount": 10944, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 10945, "estimated_amount": 10944, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 10945, "estimated_amount": 10944, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 10945, "estimated_amount": 10944, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 10945, "estimated_amount": 10944, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 10945, "estimated_amount": 10944, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 10945, "estimated_amount": 10944, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 10945, "estimated_amount": 10944, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5472.48, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5472, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8755.98, "standard_charge_percentage": 80.0000, "estimated_amount": 8755, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 10945, "estimated_amount": 10944, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 10945, "estimated_amount": 10944, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 10945, "estimated_amount": 10944, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10945, "estimated_amount": 10944, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 10945, "estimated_amount": 10944, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 10945, "estimated_amount": 10944, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 10945, "estimated_amount": 10944, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 10945, "estimated_amount": 10944, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 10945, "estimated_amount": 10944, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 10945, "estimated_amount": 10944, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 10945, "estimated_amount": 10944, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10945, "estimated_amount": 10944, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3283.49, "standard_charge_percentage": 30.0000, "estimated_amount": 3283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2143.03, "standard_charge_percentage": 19.5800, "estimated_amount": 2143, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8755.98, "standard_charge_percentage": 80.0000, "estimated_amount": 8755, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 10945, "estimated_amount": 10944, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29914", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10818.8, "discounted_cash": 10936,"minimum": 1715,"maximum": 10818.8,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 10818.8, "estimated_amount": 10818, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 10818.8, "estimated_amount": 10818, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2017.7, "standard_charge_percentage": 18.6500, "estimated_amount": 2017, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10818.8, "estimated_amount": 10818, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 10818.8, "estimated_amount": 10818, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8655, "standard_charge_percentage": 80.0000, "estimated_amount": 8655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3245.63, "standard_charge_percentage": 30.0000, "estimated_amount": 3245, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2118.31, "standard_charge_percentage": 19.5800, "estimated_amount": 2118, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8655, "standard_charge_percentage": 80.0000, "estimated_amount": 8655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 10818.8, "estimated_amount": 10818, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 10818.8, "estimated_amount": 10818, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 10818.8, "estimated_amount": 10818, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 10818.8, "estimated_amount": 10818, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5409.38, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5409, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2058.05, "standard_charge_percentage": 19.0200, "estimated_amount": 2058, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 10818.8, "estimated_amount": 10818, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 10818.8, "estimated_amount": 10818, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 10818.8, "estimated_amount": 10818, "methodology": "fee schedule" }]}]} , { "description": "Hip arthro acetabuloplasty", "code_information": [ { "code": "29915", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43821, "discounted_cash": 10936,"minimum": 1715,"maximum": 35056.8,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 13146.3, "standard_charge_percentage": 30.0000, "estimated_amount": 13146, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 8580.15, "standard_charge_percentage": 19.5800, "estimated_amount": 8580, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 13460.6, "estimated_amount": 13460, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 12362.7, "estimated_amount": 12362, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 17835.3, "estimated_amount": 17835, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 35056.8, "standard_charge_percentage": 80.0000, "estimated_amount": 35056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 8833.52, "estimated_amount": 8833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6317, "estimated_amount": 6317, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 6624, "estimated_amount": 6624, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 8172.62, "standard_charge_percentage": 18.6500, "estimated_amount": 8172, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 8336.07, "standard_charge_percentage": 19.0200, "estimated_amount": 8336, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 35056.8, "standard_charge_percentage": 80.0000, "estimated_amount": 35056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 11357.4, "estimated_amount": 11357, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 6730.3, "estimated_amount": 6730, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 8412.88, "estimated_amount": 8412, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 14478.6, "estimated_amount": 14478, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11778, "estimated_amount": 11778, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 16825.8, "estimated_amount": 16825, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "29999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7830.46, "discounted_cash": 367,"minimum": 225.99,"maximum": 6264.37,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2349.14, "standard_charge_percentage": 30.0000, "estimated_amount": 2349, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 381.36, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1460.38, "standard_charge_percentage": 18.6500, "estimated_amount": 1460, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6264.37, "standard_charge_percentage": 80.0000, "estimated_amount": 6264, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 451.98, "estimated_amount": 451, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 395.49, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 564.98, "estimated_amount": 564, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 296.61, "estimated_amount": 296, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3915.23, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3915, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1489.59, "standard_charge_percentage": 19.0200, "estimated_amount": 1489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1533.2, "standard_charge_percentage": 19.5800, "estimated_amount": 1533, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6264.37, "standard_charge_percentage": 80.0000, "estimated_amount": 6264, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 225.99, "estimated_amount": 225, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 415.12, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 598.88, "estimated_amount": 598, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 282.49, "estimated_amount": 282, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 486.17, "estimated_amount": 486, "methodology": "fee schedule" }]}]} , { "description": "Hc Drainage Of Nose Lesion", "code_information": [ { "code": "30000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1018.2, "discounted_cash": 355,"minimum": 189.89,"maximum": 1018.2,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1018.2, "estimated_amount": 1018, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 798.27, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 798, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 305.46, "standard_charge_percentage": 30.0000, "estimated_amount": 305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 546.94, "estimated_amount": 546, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 579.76, "estimated_amount": 579, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 579.76, "estimated_amount": 579, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1018.2, "estimated_amount": 1018, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 189.89, "standard_charge_percentage": 18.6500, "estimated_amount": 189, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 814.56, "standard_charge_percentage": 80.0000, "estimated_amount": 814, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 470.64, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 437.55, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 287.14, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1018.2, "estimated_amount": 1018, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1018.2, "estimated_amount": 1018, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 369.18, "estimated_amount": 369, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 382.86, "estimated_amount": 382, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 546.94, "estimated_amount": 546, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 509.1, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 509, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 798.27, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 798, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 193.69, "standard_charge_percentage": 19.0200, "estimated_amount": 193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 199.36, "standard_charge_percentage": 19.5800, "estimated_amount": 199, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 814.56, "standard_charge_percentage": 80.0000, "estimated_amount": 814, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 218.78, "estimated_amount": 218, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 470.64, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 470.64, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 401.86, "estimated_amount": 401, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" }]}]} , { "description": "Hc Scnj Blood Alcohol Serum Level Fit For Duty", "code_information": [ { "code": "30100995", "type": "CDM" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2629.31,"minimum": 490.37,"maximum": 2234.91,"payers_information":[{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 490.37, "standard_charge_percentage": 18.6500, "estimated_amount": 490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 2234.91, "standard_charge_percentage": 85.0000, "estimated_amount": 2234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 2234.91, "standard_charge_percentage": 85.0000, "estimated_amount": 2234, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 500.17, "standard_charge_percentage": 19.0200, "estimated_amount": 500, "methodology": "percent of total billed charges" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1314.65, "standard_charge_percentage": 50.0000, "estimated_amount": 1314, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 788.79, "standard_charge_percentage": 30.0000, "estimated_amount": 788, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 2061.38, "standard_charge_percentage": 78.4000, "estimated_amount": 2061, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2103.45, "standard_charge_percentage": 80.0000, "estimated_amount": 2103, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2103.45, "standard_charge_percentage": 80.0000, "estimated_amount": 2103, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 2061.38, "standard_charge_percentage": 78.4000, "estimated_amount": 2061, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "30115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17310, "discounted_cash": 4964,"minimum": 1715,"maximum": 13848,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3292.89, "standard_charge_percentage": 19.0200, "estimated_amount": 3292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3389.3, "standard_charge_percentage": 19.5800, "estimated_amount": 3389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5155.96, "estimated_amount": 5155, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3055.38, "estimated_amount": 3055, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6572.89, "estimated_amount": 6572, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6572.89, "estimated_amount": 6572, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6110.77, "estimated_amount": 6110, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7638.46, "estimated_amount": 7638, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8096.77, "estimated_amount": 8096, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8096.77, "estimated_amount": 8096, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 8655.01, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 8655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3228.32, "standard_charge_percentage": 18.6500, "estimated_amount": 3228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5612.36, "estimated_amount": 5612, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13848, "standard_charge_percentage": 80.0000, "estimated_amount": 13848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5193.01, "standard_charge_percentage": 30.0000, "estimated_amount": 5193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6572.89, "estimated_amount": 6572, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5346.92, "estimated_amount": 5346, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7638.46, "estimated_amount": 7638, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4010.19, "estimated_amount": 4010, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "30140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6645.8, "discounted_cash": 4964,"minimum": 1239.44,"maximum": 6645.8,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3055.38, "estimated_amount": 3055, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6110.77, "estimated_amount": 6110, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4010.19, "estimated_amount": 4010, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1301.25, "standard_charge_percentage": 19.5800, "estimated_amount": 1301, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6572.89, "estimated_amount": 6572, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5346.92, "estimated_amount": 5346, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6645.8, "estimated_amount": 6645, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1239.44, "standard_charge_percentage": 18.6500, "estimated_amount": 1239, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1264.23, "standard_charge_percentage": 19.0200, "estimated_amount": 1264, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5316.64, "standard_charge_percentage": 80.0000, "estimated_amount": 5316, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5316.64, "standard_charge_percentage": 80.0000, "estimated_amount": 5316, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6572.89, "estimated_amount": 6572, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 6645.8, "estimated_amount": 6645, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5612.36, "estimated_amount": 5612, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 6645.8, "estimated_amount": 6645, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 6645.8, "estimated_amount": 6645, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 3322.9, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 3322, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1993.74, "standard_charge_percentage": 30.0000, "estimated_amount": 1993, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5155.96, "estimated_amount": 5155, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6572.89, "estimated_amount": 6572, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" }]}]} , { "description": "Hc Remove Nasal Fb", "code_information": [ { "code": "30300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 524.41, "discounted_cash": 197,"minimum": 97.8,"maximum": 524.41,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 524.41, "estimated_amount": 524, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 524.41, "estimated_amount": 524, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 102.68, "standard_charge_percentage": 19.5800, "estimated_amount": 102, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 303.6, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 411.14, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 419.53, "standard_charge_percentage": 80.0000, "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 121.44, "estimated_amount": 121, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 242.88, "estimated_amount": 242, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 212.52, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 303.6, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 159.39, "estimated_amount": 159, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 321.82, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 321.82, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 262.2, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 262, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 97.8, "standard_charge_percentage": 18.6500, "estimated_amount": 97, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 99.76, "standard_charge_percentage": 19.0200, "estimated_amount": 99, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 419.53, "standard_charge_percentage": 80.0000, "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 157.32, "standard_charge_percentage": 30.0000, "estimated_amount": 157, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 204.93, "estimated_amount": 204, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 524.41, "estimated_amount": 524, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 524.41, "estimated_amount": 524, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 411.14, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 223.07, "estimated_amount": 223, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "30520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12953.1, "discounted_cash": 4964,"minimum": 1715,"maximum": 10362.5,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2415.75, "standard_charge_percentage": 18.6500, "estimated_amount": 2415, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 6572.89, "estimated_amount": 6572, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5346.92, "estimated_amount": 5346, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5612.36, "estimated_amount": 5612, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3885.92, "standard_charge_percentage": 30.0000, "estimated_amount": 3885, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 6572.89, "estimated_amount": 6572, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7638.46, "estimated_amount": 7638, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 7638.46, "estimated_amount": 7638, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4010.19, "estimated_amount": 4010, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 8096.77, "estimated_amount": 8096, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 6476.53, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 6476, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2464.06, "standard_charge_percentage": 19.0200, "estimated_amount": 2464, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 6572.89, "estimated_amount": 6572, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8096.77, "estimated_amount": 8096, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10362.5, "standard_charge_percentage": 80.0000, "estimated_amount": 10362, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2536.21, "standard_charge_percentage": 19.5800, "estimated_amount": 2536, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10362.5, "standard_charge_percentage": 80.0000, "estimated_amount": 10362, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5155.96, "estimated_amount": 5155, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3055.38, "estimated_amount": 3055, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 3819.23, "estimated_amount": 3819, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 6110.77, "estimated_amount": 6110, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "30802", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5754.54, "discounted_cash": 2267,"minimum": 1073.22,"maximum": 4603.63,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4511.56, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4511, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1073.22, "standard_charge_percentage": 18.6500, "estimated_amount": 1073, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4603.63, "standard_charge_percentage": 80.0000, "estimated_amount": 4603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 2791.1, "estimated_amount": 2791, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 3488.88, "estimated_amount": 3488, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 1831.66, "estimated_amount": 1831, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4511.56, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4511, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3002.18, "estimated_amount": 3002, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2442.22, "estimated_amount": 2442, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3698.21, "estimated_amount": 3698, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2877.27, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1726.36, "standard_charge_percentage": 30.0000, "estimated_amount": 1726, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1126.74, "standard_charge_percentage": 19.5800, "estimated_amount": 1126, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2354.99, "estimated_amount": 2354, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3002.18, "estimated_amount": 3002, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3488.88, "estimated_amount": 3488, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1744.44, "estimated_amount": 1744, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 3698.21, "estimated_amount": 3698, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1094.69, "standard_charge_percentage": 19.0200, "estimated_amount": 1094, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4603.63, "standard_charge_percentage": 80.0000, "estimated_amount": 4603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1395.55, "estimated_amount": 1395, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3002.18, "estimated_amount": 3002, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2563.45, "estimated_amount": 2563, "methodology": "fee schedule" }]}]} , { "description": "Hc Control Nose Bleed Anter Simple", "code_information": [ { "code": "30901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 524.41, "discounted_cash": 197,"minimum": 97.8,"maximum": 524.41,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 262.2, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 262, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 445.75, "standard_charge_percentage": 85.0000, "estimated_amount": 445, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 411.14, "standard_charge_percentage": 78.4000, "estimated_amount": 411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 223.07, "estimated_amount": 223, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 321.82, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 524.41, "estimated_amount": 524, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 97.8, "standard_charge_percentage": 18.6500, "estimated_amount": 97, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 445.75, "standard_charge_percentage": 85.0000, "estimated_amount": 445, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 204.93, "estimated_amount": 204, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 99.76, "standard_charge_percentage": 19.0200, "estimated_amount": 99, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 419.53, "standard_charge_percentage": 80.0000, "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 157.32, "standard_charge_percentage": 30.0000, "estimated_amount": 157, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 102.68, "standard_charge_percentage": 19.5800, "estimated_amount": 102, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 411.14, "standard_charge_percentage": 78.4000, "estimated_amount": 411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 242.88, "estimated_amount": 242, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 212.52, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 303.6, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 303.6, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 524.41, "estimated_amount": 524, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 419.53, "standard_charge_percentage": 80.0000, "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 121.44, "estimated_amount": 121, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 159.39, "estimated_amount": 159, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 321.82, "estimated_amount": 321, "methodology": "fee schedule" }]}]} , { "description": "Hc Control Nose Bleed Anter Complex", "code_information": [ { "code": "30903", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 524.41, "discounted_cash": 197,"minimum": 97.8,"maximum": 524.41,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 524.41, "estimated_amount": 524, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 262.2, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 262, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 445.75, "standard_charge_percentage": 85.0000, "estimated_amount": 445, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 102.68, "standard_charge_percentage": 19.5800, "estimated_amount": 102, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 411.14, "standard_charge_percentage": 78.4000, "estimated_amount": 411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 223.07, "estimated_amount": 223, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 321.82, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 524.41, "estimated_amount": 524, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 445.75, "standard_charge_percentage": 85.0000, "estimated_amount": 445, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 419.53, "standard_charge_percentage": 80.0000, "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 204.93, "estimated_amount": 204, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 99.76, "standard_charge_percentage": 19.0200, "estimated_amount": 99, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 157.32, "standard_charge_percentage": 30.0000, "estimated_amount": 157, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 411.14, "standard_charge_percentage": 78.4000, "estimated_amount": 411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 242.88, "estimated_amount": 242, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 212.52, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 303.6, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 303.6, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 97.8, "standard_charge_percentage": 18.6500, "estimated_amount": 97, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 419.53, "standard_charge_percentage": 80.0000, "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 121.44, "estimated_amount": 121, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 159.39, "estimated_amount": 159, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 321.82, "estimated_amount": 321, "methodology": "fee schedule" }]}]} , { "description": "Hc Control Nose Bleed Post Pack/Caut Init", "code_information": [ { "code": "30905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 524.41, "discounted_cash": 197,"minimum": 97.8,"maximum": 524.41,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 524.41, "estimated_amount": 524, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 102.68, "standard_charge_percentage": 19.5800, "estimated_amount": 102, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 411.14, "standard_charge_percentage": 78.4000, "estimated_amount": 411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 411.14, "standard_charge_percentage": 78.4000, "estimated_amount": 411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 223.07, "estimated_amount": 223, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 321.82, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 445.75, "standard_charge_percentage": 85.0000, "estimated_amount": 445, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 419.53, "standard_charge_percentage": 80.0000, "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 204.93, "estimated_amount": 204, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 262.2, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 262, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 97.8, "standard_charge_percentage": 18.6500, "estimated_amount": 97, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 445.75, "standard_charge_percentage": 85.0000, "estimated_amount": 445, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 99.76, "standard_charge_percentage": 19.0200, "estimated_amount": 99, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 419.53, "standard_charge_percentage": 80.0000, "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 157.32, "standard_charge_percentage": 30.0000, "estimated_amount": 157, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 261.25, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 242.88, "estimated_amount": 242, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 212.52, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 303.6, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 303.6, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 524.41, "estimated_amount": 524, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 121.44, "estimated_amount": 121, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 159.39, "estimated_amount": 159, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 151.8, "estimated_amount": 151, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 321.82, "estimated_amount": 321, "methodology": "fee schedule" }]}]} , { "description": "Hc Repeat Control Of Nosebleed", "code_information": [ { "code": "30906", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 768.37, "discounted_cash": 355,"minimum": 143.3,"maximum": 768.37,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 768.37, "estimated_amount": 768, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 384.19, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 384, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 143.3, "standard_charge_percentage": 18.6500, "estimated_amount": 143, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 653.11, "standard_charge_percentage": 85.0000, "estimated_amount": 653, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 146.17, "standard_charge_percentage": 19.0200, "estimated_amount": 146, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 150.45, "standard_charge_percentage": 19.5800, "estimated_amount": 150, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 602.4, "standard_charge_percentage": 78.4000, "estimated_amount": 602, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 369.18, "estimated_amount": 369, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 470.64, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 287.14, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 614.7, "standard_charge_percentage": 80.0000, "estimated_amount": 614, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 470.64, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 546.94, "estimated_amount": 546, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 579.76, "estimated_amount": 579, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 768.37, "estimated_amount": 768, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 653.11, "standard_charge_percentage": 85.0000, "estimated_amount": 653, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 614.7, "standard_charge_percentage": 80.0000, "estimated_amount": 614, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 230.51, "standard_charge_percentage": 30.0000, "estimated_amount": 230, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 218.78, "estimated_amount": 218, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 470.64, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 401.86, "estimated_amount": 401, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 602.4, "standard_charge_percentage": 78.4000, "estimated_amount": 602, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 437.55, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 382.86, "estimated_amount": 382, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 546.94, "estimated_amount": 546, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 579.76, "estimated_amount": 579, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "31000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4057.03, "discounted_cash": 355,"minimum": 218.78,"maximum": 3245.62,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 756.64, "standard_charge_percentage": 18.6500, "estimated_amount": 756, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 771.77, "standard_charge_percentage": 19.0200, "estimated_amount": 771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3245.62, "standard_charge_percentage": 80.0000, "estimated_amount": 3245, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 470.64, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 546.94, "estimated_amount": 546, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 579.76, "estimated_amount": 579, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2028.52, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2028, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3180.71, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 369.18, "estimated_amount": 369, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 401.86, "estimated_amount": 401, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 287.14, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3180.71, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3245.62, "standard_charge_percentage": 80.0000, "estimated_amount": 3245, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1217.11, "standard_charge_percentage": 30.0000, "estimated_amount": 1217, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 794.37, "standard_charge_percentage": 19.5800, "estimated_amount": 794, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 218.78, "estimated_amount": 218, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 470.64, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 470.64, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 437.55, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 382.86, "estimated_amount": 382, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 546.94, "estimated_amount": 546, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 579.76, "estimated_amount": 579, "methodology": "fee schedule" }]}]} , { "description": "Hc Nasal Endo Dx, Unilateral Or Bilateral", "code_information": [ { "code": "31231", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 753, "discounted_cash": 297,"minimum": 140.43,"maximum": 753,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 753, "estimated_amount": 753, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 376.5, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 376, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 602.4, "standard_charge_percentage": 80.0000, "estimated_amount": 602, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 182.9, "estimated_amount": 182, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 365.81, "estimated_amount": 365, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 320.08, "estimated_amount": 320, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 753, "estimated_amount": 753, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 140.43, "standard_charge_percentage": 18.6500, "estimated_amount": 140, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 602.4, "standard_charge_percentage": 80.0000, "estimated_amount": 602, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 308.65, "estimated_amount": 308, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 393.47, "estimated_amount": 393, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 335.97, "estimated_amount": 335, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 484.7, "estimated_amount": 484, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 753, "estimated_amount": 753, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 590.35, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 590, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 143.24, "standard_charge_percentage": 19.0200, "estimated_amount": 143, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 225.9, "standard_charge_percentage": 30.0000, "estimated_amount": 225, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 147.44, "standard_charge_percentage": 19.5800, "estimated_amount": 147, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 393.47, "estimated_amount": 393, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 240.06, "estimated_amount": 240, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 753, "estimated_amount": 753, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 590.35, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 590, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 393.47, "estimated_amount": 393, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 457.26, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 457.26, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 484.7, "estimated_amount": 484, "methodology": "fee schedule" }]}]} , { "description": "Hc Nasal Endo Sx,Bx/Polypectomy/Debridement", "code_information": [ { "code": "31237", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4549.5, "discounted_cash": 2640,"minimum": 848.48,"maximum": 12312,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 865.45, "standard_charge_percentage": 19.0200, "estimated_amount": 865, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3639.6, "standard_charge_percentage": 80.0000, "estimated_amount": 3639, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3639.6, "standard_charge_percentage": 80.0000, "estimated_amount": 3639, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1624.66, "estimated_amount": 1624, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3495.06, "estimated_amount": 3495, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2132.37, "estimated_amount": 2132, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4305.36, "estimated_amount": 4305, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 7695, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 7695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3495.06, "estimated_amount": 3495, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2843.16, "estimated_amount": 2843, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2274.75, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2274, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1364.85, "standard_charge_percentage": 30.0000, "estimated_amount": 1364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 890.79, "standard_charge_percentage": 19.5800, "estimated_amount": 890, "methodology": "percent of total billed charges" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4617, "standard_charge_percentage": 30.0000, "estimated_amount": 4617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 3013.36, "standard_charge_percentage": 19.5800, "estimated_amount": 3013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2741.62, "estimated_amount": 2741, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1624.66, "estimated_amount": 1624, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3495.06, "estimated_amount": 3495, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3249.33, "estimated_amount": 3249, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4061.66, "estimated_amount": 4061, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4305.36, "estimated_amount": 4305, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3566.81, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3566, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2741.62, "estimated_amount": 2741, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3249.33, "estimated_amount": 3249, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2843.16, "estimated_amount": 2843, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4061.66, "estimated_amount": 4061, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2870.24, "standard_charge_percentage": 18.6500, "estimated_amount": 2870, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2927.64, "standard_charge_percentage": 19.0200, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3495.06, "estimated_amount": 3495, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2984.3, "estimated_amount": 2984, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2132.37, "estimated_amount": 2132, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4305.36, "estimated_amount": 4305, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3566.81, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3566, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 848.48, "standard_charge_percentage": 18.6500, "estimated_amount": 848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3495.06, "estimated_amount": 3495, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3495.06, "estimated_amount": 3495, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4061.66, "estimated_amount": 4061, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2984.3, "estimated_amount": 2984, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4305.36, "estimated_amount": 4305, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12312, "standard_charge_percentage": 80.0000, "estimated_amount": 12312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4061.66, "estimated_amount": 4061, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "31240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4456.29, "discounted_cash": 2640,"minimum": 831.1,"maximum": 4415,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2228.14, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3493.73, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3493, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3565.03, "standard_charge_percentage": 80.0000, "estimated_amount": 3565, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3565.03, "standard_charge_percentage": 80.0000, "estimated_amount": 3565, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3495.06, "estimated_amount": 3495, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2843.16, "estimated_amount": 2843, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2984.3, "estimated_amount": 2984, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2741.62, "estimated_amount": 2741, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3495.06, "estimated_amount": 3495, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3249.33, "estimated_amount": 3249, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4061.66, "estimated_amount": 4061, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3493.73, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3493, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 847.72, "standard_charge_percentage": 19.0200, "estimated_amount": 847, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1336.89, "standard_charge_percentage": 30.0000, "estimated_amount": 1336, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 872.54, "standard_charge_percentage": 19.5800, "estimated_amount": 872, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1624.66, "estimated_amount": 1624, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4061.66, "estimated_amount": 4061, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4305.36, "estimated_amount": 4305, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 831.1, "standard_charge_percentage": 18.6500, "estimated_amount": 831, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3495.06, "estimated_amount": 3495, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2132.37, "estimated_amount": 2132, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4305.36, "estimated_amount": 4305, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "31253", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5770, "discounted_cash": 10598,"minimum": 1076.1,"maximum": 5770,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4616, "standard_charge_percentage": 80.0000, "estimated_amount": 4616, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4616, "standard_charge_percentage": 80.0000, "estimated_amount": 4616, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5169, "estimated_amount": 5169, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5378, "estimated_amount": 5378, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4523.68, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4523, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 1076.1, "standard_charge_percentage": 18.6500, "estimated_amount": 1076, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2885, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2885, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4523.68, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4523, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 1097.63, "standard_charge_percentage": 19.0200, "estimated_amount": 1097, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1731, "standard_charge_percentage": 30.0000, "estimated_amount": 1731, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 1129.77, "standard_charge_percentage": 19.5800, "estimated_amount": 1129, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5770, "estimated_amount": 5770, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "31254", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4713.88, "discounted_cash": 10598,"minimum": 879.14,"maximum": 4713.88,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3771.1, "standard_charge_percentage": 80.0000, "estimated_amount": 3771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1414.16, "standard_charge_percentage": 30.0000, "estimated_amount": 1414, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 4713.88, "estimated_amount": 4713, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 4713.88, "estimated_amount": 4713, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 4713.88, "estimated_amount": 4713, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 4713.88, "estimated_amount": 4713, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4713.88, "estimated_amount": 4713, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 4713.88, "estimated_amount": 4713, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4713.88, "estimated_amount": 4713, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4713.88, "estimated_amount": 4713, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2356.94, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2356, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3695.68, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 879.14, "standard_charge_percentage": 18.6500, "estimated_amount": 879, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 896.72, "standard_charge_percentage": 19.0200, "estimated_amount": 896, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 922.98, "standard_charge_percentage": 19.5800, "estimated_amount": 922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 4713.88, "estimated_amount": 4713, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 4713.88, "estimated_amount": 4713, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 4713.88, "estimated_amount": 4713, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4713.88, "estimated_amount": 4713, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4713.88, "estimated_amount": 4713, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3695.68, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 4713.88, "estimated_amount": 4713, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 4713.88, "estimated_amount": 4713, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4713.88, "estimated_amount": 4713, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4713.88, "estimated_amount": 4713, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 4713.88, "estimated_amount": 4713, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 4713.88, "estimated_amount": 4713, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3771.1, "standard_charge_percentage": 80.0000, "estimated_amount": 3771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4713.88, "estimated_amount": 4713, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 4713.88, "estimated_amount": 4713, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 4713.88, "estimated_amount": 4713, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 4713.88, "estimated_amount": 4713, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "31255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4688.13, "discounted_cash": 10598,"minimum": 874.34,"maximum": 4688.13,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4688.13, "estimated_amount": 4688, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2344.07, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2344, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 874.34, "standard_charge_percentage": 18.6500, "estimated_amount": 874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 4688.13, "estimated_amount": 4688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 4688.13, "estimated_amount": 4688, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 4688.13, "estimated_amount": 4688, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 4688.13, "estimated_amount": 4688, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 4688.13, "estimated_amount": 4688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4688.13, "estimated_amount": 4688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4688.13, "estimated_amount": 4688, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 4688.13, "estimated_amount": 4688, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 4688.13, "estimated_amount": 4688, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 4688.13, "estimated_amount": 4688, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 4688.13, "estimated_amount": 4688, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3750.5, "standard_charge_percentage": 80.0000, "estimated_amount": 3750, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 917.94, "standard_charge_percentage": 19.5800, "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3750.5, "standard_charge_percentage": 80.0000, "estimated_amount": 3750, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4688.13, "estimated_amount": 4688, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 4688.13, "estimated_amount": 4688, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 4688.13, "estimated_amount": 4688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 4688.13, "estimated_amount": 4688, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4688.13, "estimated_amount": 4688, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 4688.13, "estimated_amount": 4688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4688.13, "estimated_amount": 4688, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3675.49, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3675, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3675.49, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3675, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 891.82, "standard_charge_percentage": 19.0200, "estimated_amount": 891, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1406.44, "standard_charge_percentage": 30.0000, "estimated_amount": 1406, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 4688.13, "estimated_amount": 4688, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4688.13, "estimated_amount": 4688, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4688.13, "estimated_amount": 4688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4688.13, "estimated_amount": 4688, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4688.13, "estimated_amount": 4688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 4688.13, "estimated_amount": 4688, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "31256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4567.92, "discounted_cash": 5644,"minimum": 851.92,"maximum": 4567.92,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3581.25, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3581, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3654.34, "standard_charge_percentage": 80.0000, "estimated_amount": 3654, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 4341.97, "estimated_amount": 4341, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 4341.97, "estimated_amount": 4341, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 4567.92, "estimated_amount": 4567, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4567.92, "estimated_amount": 4567, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 4341.97, "estimated_amount": 4341, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 868.96, "standard_charge_percentage": 19.0200, "estimated_amount": 868, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3654.34, "standard_charge_percentage": 80.0000, "estimated_amount": 3654, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 894.4, "standard_charge_percentage": 19.5800, "estimated_amount": 894, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 4341.97, "estimated_amount": 4341, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 4341.97, "estimated_amount": 4341, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4567.92, "estimated_amount": 4567, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3581.25, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3581, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 851.92, "standard_charge_percentage": 18.6500, "estimated_amount": 851, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1370.38, "standard_charge_percentage": 30.0000, "estimated_amount": 1370, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 4341.97, "estimated_amount": 4341, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 4567.92, "estimated_amount": 4567, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 4567.92, "estimated_amount": 4567, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4567.92, "estimated_amount": 4567, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4567.92, "estimated_amount": 4567, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 4341.97, "estimated_amount": 4341, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 4341.97, "estimated_amount": 4341, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4559.07, "estimated_amount": 4559, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 4341.97, "estimated_amount": 4341, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2283.96, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4567.92, "estimated_amount": 4567, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 4341.97, "estimated_amount": 4341, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 3473.58, "estimated_amount": 3473, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 4567.92, "estimated_amount": 4567, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4567.92, "estimated_amount": 4567, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4567.92, "estimated_amount": 4567, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "31259", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4550.74, "discounted_cash": 10598,"minimum": 848.71,"maximum": 4550.74,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 848.71, "standard_charge_percentage": 18.6500, "estimated_amount": 848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1365.22, "standard_charge_percentage": 30.0000, "estimated_amount": 1365, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2275.37, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2275, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3567.78, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3567, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3640.59, "standard_charge_percentage": 80.0000, "estimated_amount": 3640, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 891.03, "standard_charge_percentage": 19.5800, "estimated_amount": 891, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3567.78, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3567, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 865.69, "standard_charge_percentage": 19.0200, "estimated_amount": 865, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3640.59, "standard_charge_percentage": 80.0000, "estimated_amount": 3640, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "31267", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4550.74, "discounted_cash": 10598,"minimum": 848.71,"maximum": 4550.74,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4020, "estimated_amount": 4020, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4415, "estimated_amount": 4415, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 848.71, "standard_charge_percentage": 18.6500, "estimated_amount": 848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 891.03, "standard_charge_percentage": 19.5800, "estimated_amount": 891, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2275.37, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2275, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3567.78, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3567, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3640.59, "standard_charge_percentage": 80.0000, "estimated_amount": 3640, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1365.22, "standard_charge_percentage": 30.0000, "estimated_amount": 1365, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3640.59, "standard_charge_percentage": 80.0000, "estimated_amount": 3640, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3567.78, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3567, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 865.69, "standard_charge_percentage": 19.0200, "estimated_amount": 865, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "31276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4550.74, "discounted_cash": 10598,"minimum": 848.71,"maximum": 4550.74,"payers_information":[{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2275.37, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2275, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3567.78, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3567, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3567.78, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3567, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3640.59, "standard_charge_percentage": 80.0000, "estimated_amount": 3640, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 848.71, "standard_charge_percentage": 18.6500, "estimated_amount": 848, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 865.69, "standard_charge_percentage": 19.0200, "estimated_amount": 865, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 891.03, "standard_charge_percentage": 19.5800, "estimated_amount": 891, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1365.22, "standard_charge_percentage": 30.0000, "estimated_amount": 1365, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3640.59, "standard_charge_percentage": 80.0000, "estimated_amount": 3640, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4550.74, "estimated_amount": 4550, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "31287", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2472.85, "discounted_cash": 10598,"minimum": 461.19,"maximum": 2472.85,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2472.85, "estimated_amount": 2472, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2472.85, "estimated_amount": 2472, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 741.86, "standard_charge_percentage": 30.0000, "estimated_amount": 741, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2472.85, "estimated_amount": 2472, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2472.85, "estimated_amount": 2472, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 2472.85, "estimated_amount": 2472, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 2472.85, "estimated_amount": 2472, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 2472.85, "estimated_amount": 2472, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 1236.42, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 1236, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 1938.71, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1938, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1978.28, "standard_charge_percentage": 80.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 2472.85, "estimated_amount": 2472, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 2472.85, "estimated_amount": 2472, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2472.85, "estimated_amount": 2472, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 2472.85, "estimated_amount": 2472, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 1938.71, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 1938, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 484.18, "standard_charge_percentage": 19.5800, "estimated_amount": 484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2472.85, "estimated_amount": 2472, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2472.85, "estimated_amount": 2472, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 2472.85, "estimated_amount": 2472, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2472.85, "estimated_amount": 2472, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 2472.85, "estimated_amount": 2472, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2472.85, "estimated_amount": 2472, "methodology": "fee schedule" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 461.19, "standard_charge_percentage": 18.6500, "estimated_amount": 461, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 470.41, "standard_charge_percentage": 19.0200, "estimated_amount": 470, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1978.28, "standard_charge_percentage": 80.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2472.85, "estimated_amount": 2472, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 2472.85, "estimated_amount": 2472, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 2472.85, "estimated_amount": 2472, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 2472.85, "estimated_amount": 2472, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 2472.85, "estimated_amount": 2472, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2472.85, "estimated_amount": 2472, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 2472.85, "estimated_amount": 2472, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2472.85, "estimated_amount": 2472, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "31296", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5048.75, "discounted_cash": 10598,"minimum": 941.59,"maximum": 5048.75,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5048.75, "estimated_amount": 5048, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 5048.75, "estimated_amount": 5048, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 3958.22, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 988.55, "standard_charge_percentage": 19.5800, "estimated_amount": 988, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4039, "standard_charge_percentage": 80.0000, "estimated_amount": 4039, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 5048.75, "estimated_amount": 5048, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 5048.75, "estimated_amount": 5048, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 5048.75, "estimated_amount": 5048, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 5048.75, "estimated_amount": 5048, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 5048.75, "estimated_amount": 5048, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2524.38, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2524, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 941.59, "standard_charge_percentage": 18.6500, "estimated_amount": 941, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1514.63, "standard_charge_percentage": 30.0000, "estimated_amount": 1514, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 5048.75, "estimated_amount": 5048, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5048.75, "estimated_amount": 5048, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 3958.22, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 3958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4039, "standard_charge_percentage": 80.0000, "estimated_amount": 4039, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 5048.75, "estimated_amount": 5048, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5048.75, "estimated_amount": 5048, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 5048.75, "estimated_amount": 5048, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 5048.75, "estimated_amount": 5048, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 5048.75, "estimated_amount": 5048, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 5048.75, "estimated_amount": 5048, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 5048.75, "estimated_amount": 5048, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 5048.75, "estimated_amount": 5048, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 960.42, "standard_charge_percentage": 19.0200, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 5048.75, "estimated_amount": 5048, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 5048.75, "estimated_amount": 5048, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 5048.75, "estimated_amount": 5048, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 5048.75, "estimated_amount": 5048, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 5048.75, "estimated_amount": 5048, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 5048.75, "estimated_amount": 5048, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 5048.75, "estimated_amount": 5048, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 5048.75, "estimated_amount": 5048, "methodology": "fee schedule" }]}]} , { "description": "Hc Intubation Endotracheal", "code_information": [ { "code": "31500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1002.73, "discounted_cash": 355,"minimum": 187.01,"maximum": 16408.8,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1002.73, "estimated_amount": 1002, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 501.37, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 501, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1002.73, "estimated_amount": 1002, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 190.75, "standard_charge_percentage": 19.0200, "estimated_amount": 190, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 369.18, "estimated_amount": 369, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 470.64, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 382.86, "estimated_amount": 382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 401.86, "estimated_amount": 401, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6153.3, "standard_charge_percentage": 30.0000, "estimated_amount": 6153, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 16408.8, "standard_charge_percentage": 80.0000, "estimated_amount": 16408, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 369.18, "estimated_amount": 369, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 401.86, "estimated_amount": 401, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 287.14, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 786.14, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 786, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 786.14, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 786, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 802.18, "standard_charge_percentage": 80.0000, "estimated_amount": 802, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 802.18, "standard_charge_percentage": 80.0000, "estimated_amount": 802, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 218.78, "estimated_amount": 218, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 470.64, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 546.94, "estimated_amount": 546, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 470.64, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 546.94, "estimated_amount": 546, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 579.76, "estimated_amount": 579, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1002.73, "estimated_amount": 1002, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 287.14, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 2297, "estimated_amount": 2297, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 9088, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 9088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 3901.81, "standard_charge_percentage": 19.0200, "estimated_amount": 3901, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 218.78, "estimated_amount": 218, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 470.64, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 1002.73, "estimated_amount": 1002, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 187.01, "standard_charge_percentage": 18.6500, "estimated_amount": 187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 300.82, "standard_charge_percentage": 30.0000, "estimated_amount": 300, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 196.33, "standard_charge_percentage": 19.5800, "estimated_amount": 196, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 470.64, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 437.55, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 546.94, "estimated_amount": 546, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 579.76, "estimated_amount": 579, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 579.76, "estimated_amount": 579, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3057, "estimated_amount": 3057, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 3825.3, "standard_charge_percentage": 18.6500, "estimated_amount": 3825, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 16408.8, "standard_charge_percentage": 80.0000, "estimated_amount": 16408, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 4016.05, "standard_charge_percentage": 19.5800, "estimated_amount": 4016, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 470.64, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 437.55, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 382.86, "estimated_amount": 382, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 546.94, "estimated_amount": 546, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 273.47, "estimated_amount": 273, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 579.76, "estimated_amount": 579, "methodology": "fee schedule" }]}]} , { "description": "Hc Laryngoscopy Indirect Diagnostic", "code_information": [ { "code": "31505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 611.19, "discounted_cash": 297,"minimum": 113.99,"maximum": 611.19,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 611.19, "estimated_amount": 611, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 611.19, "estimated_amount": 611, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 479.17, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 116.27, "standard_charge_percentage": 19.0200, "estimated_amount": 116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 457.26, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 240.06, "estimated_amount": 240, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 484.7, "estimated_amount": 484, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 611.19, "estimated_amount": 611, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 488.95, "standard_charge_percentage": 80.0000, "estimated_amount": 488, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 308.65, "estimated_amount": 308, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 393.47, "estimated_amount": 393, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 365.81, "estimated_amount": 365, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 320.08, "estimated_amount": 320, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 305.6, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 488.95, "standard_charge_percentage": 80.0000, "estimated_amount": 488, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 183.36, "standard_charge_percentage": 30.0000, "estimated_amount": 183, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 119.67, "standard_charge_percentage": 19.5800, "estimated_amount": 119, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 182.9, "estimated_amount": 182, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 335.97, "estimated_amount": 335, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 611.19, "estimated_amount": 611, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 479.17, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 113.99, "standard_charge_percentage": 18.6500, "estimated_amount": 113, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 393.47, "estimated_amount": 393, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 393.47, "estimated_amount": 393, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 457.26, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 484.7, "estimated_amount": 484, "methodology": "fee schedule" }]}]} , { "description": "Hc Laryngoscopy, Indirect+Remv For.Body", "code_information": [ { "code": "31511", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 611.19, "discounted_cash": 297,"minimum": 113.99,"maximum": 611.19,"payers_information":[{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 611.19, "estimated_amount": 611, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 479.17, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 113.99, "standard_charge_percentage": 18.6500, "estimated_amount": 113, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 308.65, "estimated_amount": 308, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 393.47, "estimated_amount": 393, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 305.6, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 479.17, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 183.36, "standard_charge_percentage": 30.0000, "estimated_amount": 183, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 119.67, "standard_charge_percentage": 19.5800, "estimated_amount": 119, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 488.95, "standard_charge_percentage": 80.0000, "estimated_amount": 488, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 457.26, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 457.26, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 484.7, "estimated_amount": 484, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 611.19, "estimated_amount": 611, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 116.27, "standard_charge_percentage": 19.0200, "estimated_amount": 116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 488.95, "standard_charge_percentage": 80.0000, "estimated_amount": 488, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 393.47, "estimated_amount": 393, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 393.47, "estimated_amount": 393, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 365.81, "estimated_amount": 365, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 240.06, "estimated_amount": 240, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 484.7, "estimated_amount": 484, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 611.19, "estimated_amount": 611, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 611.19, "estimated_amount": 611, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 182.9, "estimated_amount": 182, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 320.08, "estimated_amount": 320, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 335.97, "estimated_amount": 335, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 228.63, "estimated_amount": 228, "methodology": "fee schedule" }]}]} , { "description": "Hc Laryngoscopy Direct Diagnostic", "code_information": [ { "code": "31525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5103.92, "discounted_cash": 2640,"minimum": 951.88,"maximum": 4305.36,"payers_information":[{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 4001.47, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4001, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2741.62, "estimated_amount": 2741, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3495.06, "estimated_amount": 3495, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4305.36, "estimated_amount": 4305, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 951.88, "standard_charge_percentage": 18.6500, "estimated_amount": 951, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4083.14, "standard_charge_percentage": 80.0000, "estimated_amount": 4083, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3495.06, "estimated_amount": 3495, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4061.66, "estimated_amount": 4061, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2984.3, "estimated_amount": 2984, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 2551.96, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 2551, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 4001.47, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 4001, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 970.92, "standard_charge_percentage": 19.0200, "estimated_amount": 970, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 999.35, "standard_charge_percentage": 19.5800, "estimated_amount": 999, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4083.14, "standard_charge_percentage": 80.0000, "estimated_amount": 4083, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1624.66, "estimated_amount": 1624, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4061.66, "estimated_amount": 4061, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4305.36, "estimated_amount": 4305, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1531.18, "standard_charge_percentage": 30.0000, "estimated_amount": 1531, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3495.06, "estimated_amount": 3495, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3249.33, "estimated_amount": 3249, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2843.16, "estimated_amount": 2843, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2132.37, "estimated_amount": 2132, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "31526", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11540, "discounted_cash": 2640,"minimum": 1624.66,"maximum": 9232,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3676, "estimated_amount": 3676, "methodology": "case rate" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "standard_charge_dollar": 5770, "standard_charge_percentage": 50.0000,"standard_charge_algorithm": "Not To Exceed $9088", "estimated_amount": 5770, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "standard_charge_dollar": 2152.21, "standard_charge_percentage": 18.6500, "estimated_amount": 2152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "standard_charge_dollar": 2259.53, "standard_charge_percentage": 19.5800, "estimated_amount": 2259, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9232, "standard_charge_percentage": 80.0000, "estimated_amount": 9232, "methodology": "percent of total billed charges" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "standard_charge_dollar": 3495.06, "estimated_amount": 3495, "methodology": "fee schedule" } ,{ "payer_name": "Americhoice", "plan_name": "UHC Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "standard_charge_dollar": 1978, "estimated_amount": 1978, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3462, "standard_charge_percentage": 30.0000, "estimated_amount": 3462, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "standard_charge_dollar": 2741.62, "estimated_amount": 2741, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "standard_charge_dollar": 3495.06, "estimated_amount": 3495, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Auto", "standard_charge_dollar": 4061.66, "estimated_amount": 4061, "methodology": "fee schedule" } ,{ "payer_name": "Clover Health", "plan_name": "Clover Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 03-31-2026)", "standard_charge_dollar": 3912, "estimated_amount": 3912, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 03-31-2026)", "standard_charge_dollar": 2195.25, "standard_charge_percentage": 19.0200, "estimated_amount": 2195, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "standard_charge_dollar": 3495.06, "estimated_amount": 3495, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial", "standard_charge_dollar": 2984.3, "estimated_amount": 2984, "methodology": "fee schedule" } ,{ "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "standard_charge_dollar": 2132.37, "estimated_amount": 2132, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "standard_charge_dollar": 4305.36, "estimated_amount": 4305, "methodology": "fee schedule" } ,{ "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "standard_charge_dollar": 1715, "estimated_amount": 1715, "methodology": "case rate" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "standard_charge_dollar": 5182, "standard_charge_percentage": 78.4000,"standard_charge_algorithm": "Not To Exceed $5182", "estimated_amount": 5182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9232, "standard_charge_percentage": 80.0000, "estimated_amount": 9232, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Military Tricare", "standard_charge_dollar": 1624.66, "estimated_amount": 1624, "methodology": "fee schedule" } ,{ "payer_name": "Horizon", "plan_name": "Horizon Medicare", "standard_charge_dollar": 2030.83, "estimated_amount": 2030, "methodology": "fee schedule" } ,{ "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "standard_charge_dollar": 3249.33, "estimated_amount": 3249, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2843.16, "estimated_amount": 2843, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4061.66, "estimated_amount": 4061, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4305.36, "estimated_amount": 4305, "methodology": "fee schedule" }]}]} , { "description": "Hc Laryngoscopy W/Foreign Body Removal", "code_information": [ { "code": "31530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5103.92, "discounted_cash": 2640,"minimum": 337,"m